Tag: opioid abuse

House Committee advances prescription drug monitoring proposal

The Missouri House is again being asked to consider creating a statewide prescription drug monitoring program (PDMP), with the aim of battling the abuse of opioids and other prescription medication.

Representative Holly Rehder presents to a committee House Bill 188, which would create a statewide prescription drug monitoring program in Missouri. Behind her, Senator Tony Leutkemeyer (R-Parkville) listens to the discussion. Luetkemeyer is sponsoring identical legislation in the Senate. (photo; Tim Bommel, Missouri House Communications)

House Bill 188 is sponsored by Sikeston Republican Holly Rehder, who has proposed a statewide PDMP for several years.  Such legislation has passed out of the House several times but was held up in the Senate.

Rehder has been a strong proponent of PDMPs largely because of her family’s experience with opioid and drug abuse.  One of her step-fathers was a drug dealer.  Her daughter, Raychel, became addicted to pain relievers after an emergency room visit when she was 17.  She went on to abuse other substances including methamphetamine before becoming drug-free more than 5-years ago.  Rehder says other members of her family have also struggled with abuse issues.

“I know this issue inside and out, as a parent, as a kid who grew up in it, and it doesn’t matter what your background is, it doesn’t matter how you grow up or how you raise your children.  It’s not a moral failing.  Addiction is a disease,” Rehder told the House Committee on Insurance Policy.

Missouri is the only state in the nation without a PDMP.  Such programs collect and monitor drug prescription and dispensing data to look for, among other things, “doctor shopping;” the visiting of multiple doctors in an attempt to obtain drugs that are commonly abused.

Rehder and other supporters say they don’t view PDMPs as a “silver bullet,” that will end the abuse of opioids and other prescription drugs, but as a tool that will help fight such abuse.

“A PDMP allows providers to see concerning trends in their patients’ narcotic history.  That physician can intervene with options for that patient:  alternative care treatment, medication-assisted treatment – we have many options available now with excellent outcomes, but we need our medical professionals seeing their patients’ history before they get too far down the road,” said Rehder.

Opponents of PDMPs argue that they violate citizens’ rights by collecting personal data and putting it into a government database that, they say, could then be jeopardized by hacking or other breaches.

Doctor John Lilly of Springfield told lawmakers they should put privacy concerns above all others in considering PDMP legislation.

“Your job is not to make my job easier.  Your job is to protect the liberty of the citizens of this state,” said Dr. Lilly.  “I am a U.S. citizen first and a doctor second.  I care about the liberty of these citizens of Missouri.”

Lilly and others speaking against HB 188 argued that data show PDMPs in other states have not been effective in fighting opioid abuse.

Monroe County Commissioner Ron Staggs asked the committee, “After you see the data from 49 states and a death rate that continues to climb why would you want to enact the same thing?”

Proponents say a PDMP wouldn’t just address drug abuse in Missouri.  It could also help pharmacists spot cases in which patients might be prescribed unsafe combinations of medications.

Anne Eisenbeis works at a pharmacy in Moberly.  She told the committee of one such instance that she caught by chance, that a PDMP would have ensured was flagged.

“I had a patient and a friend – a young man – bring in two prescriptions from two different doctors for two almost identical narcotics … had he not brought both physical prescriptions into my store, because in Moberly we don’t have access to the PDMP … he would’ve easily overdosed.  There would’ve been an interaction with these two medications,” said Eisenbeis.  “With a PDMP this would help me prevent this kind of medication error accident.  I would’ve been able to see that he was given another prescription had he gone to another pharmacy.”

In previous years one of the proponents of a PDMP in the Senate has been Senator Dave Schatz (R-Sullivan), who is now the President Pro-Tem of the Senate.  Rehder said she and Schatz worked in past years on compromises that have been worked into HB 188, and having him in Senate leadership bolsters the chance PDMP will become law this year.

The committee voted 13-3 to pass HB 188.  It goes next to another House committee, which could vote on whether to send it to the full chamber for consideration.

House approves bill taking multiple approaches to opioid addiction fight

The Missouri House has voted to take more steps toward fighting opioid addiction, with more such efforts likely to come from the chamber before the session ends in May.

Representative Keith Frederick (photo; Tim Bommel, Missouri House Communications – click for larger version)

House Bill 2105 has been sent to the state Senate for consideration.  The bill has a number of provisions.  Sponsor Keith Frederick (R-Rolla) said the overarching idea behind the bill is to see a shift in the response to opioid addiction from law enforcement and incarceration to treatment availability.

“That’s the thing that’s lacking so much now, is we don’t have enough health care providers to provide access to what’s called, ‘medication assisted therapy,’” said Frederick.  “It is basically using medications like buprenorphine and Suboxone that get rid of the craving for narcotics and it allows people to get back to a useful, functional, rewarding life, but they need the medication on an ongoing basis and for that we need healthcare providers to help provide access to that sort of treatment, and we don’t have enough of those now.”

Frederick said the main provision of HB 2105 would create the “Improved Access to Treatment for Opioid Addictions” Program (IATOA).  It would use assistant physicians – a position created by legislation passed in 2014 – to work in a collaborative way with licensed doctors to provide addiction treatment throughout the state.

Those assistant physicians will be supported by the ECHO program (Extension for Community Healthcare Options) – a program that uses videoconferencing to connect experts with providers statewide to help providers offer specialized care.  Frederick said a module has been created for ECHO that focuses on opioid addiction treatment.

“These assistant physicians will have to become waivered – so they have to take a course on addiction treatment, and then they submit that to the DEA – the DEA can then give them a waiver to prescribe this medication, then they have to work in a collaboration with an experienced addiction treatment specialist, and then they’re also supported by the ongoing education of the ECHO opioid addiction module,” said Frederick.  “It’s a wonderful, collaborative way to bring access to this really life-changing, life-saving treatment to people struggling with addiction instead of their ending up in prison.”

Frederick said this program would be among the first of its kind in the nation, and other states are already taking note of it and considering how to create their own.

Another of HB 2105’s main provisions would limit to a seven-day supply the amount of an opioid drug that could be prescribed to someone for acute pain.  Frederick said this is meant to keep people from becoming addicted while not limiting such drugs to those who rely on them for long-term pain management.

“The difference between somebody who’s addicted and somebody who’s dependent is a pretty big difference,” said Frederick.  “The idea is to prevent people like the high school athlete who has a knee injury and the doc gives him 150 Percocet or whatever – it’s to nip that in the bud; prevent new people from getting addicted, but while acknowledging that there are people in our state that have chronic pain and they’re getting along pretty well, thank you very much.  So, I don’t believe we should be going after that patient that is needing ongoing medication on a regular basis but their life is stable and they’re doing well.”

Representative Jay Barnes (photo; Tim Bommel, Missouri House Communications – click for larger version)

The bill would also create the Prescription Abuse Registry – a registry a person could voluntarily add himself or herself to – for individuals who have struggled with addiction.  The registry would do no more than notify doctors who choose to check it that those on the list have had a substance abuse problem.  That language was added by Representative Jay Barnes (R-Jefferson City).

“I think a lot of times people with substance abuse problems, at some point in their life they try to get clean,” Barnes said.  “At that point in time … they’re in a position when they may want to put themselves on a list like this, but if they have a relapse … being on a list like this would give providers a tool that if they suspect the person of doctor shopping, to check the list and say, ‘What’s going on here?  I know that you’re on this list.  I know that you’ve had a problem with opioids in the past … what are we doing?’”

A person could petition to be removed from the list five years after adding her or his name to it.

Other provisions in HB 2105 would create a drug take-back program for disposal of unused prescriptions; and bar the Department of Corrections from preventing offenders from receiving medication-assisted treatment for substance abuse or dependence.

The bill would also discontinue patient satisfaction scores of doctors, to the extent allowed by federal law.  Frederick said this is to keep doctors from being giving low scores by patients with addiction issues to whom they refused to prescribe opioids.  Such false, punitive low scoring can hurt doctors’ reputations, and hurt them financially.

The House voted 128-4 to send HB 2105 to the Senate.  Representative Frederick is also handling HCB 15 which will also contain multiple provisions aimed at fighting opioid abuse.  That legislation could be coming out of the committee process and ready for debate in the full House in the next few weeks.

House approves bipartisan collaborative effort to extend Medicaid coverage for postpartum substance abuse care

A bipartisan, collaborative effort to extend Medicaid benefits for postpartum substance abuse treatment has been approved by the Missouri House.

Representatives Marsha Haefner, Martha Stevens, Cora Faith Walker, and Jay Barnes (photos; Tim Bommel, Missouri House Communications – click for larger version)

House Bill 2280 extends MO HealthNet benefits for pregnant women who are receiving substance abuse treatment within 60 days of giving birth for up to 12 additional months.  Any participating woman must follow the treatment in order to benefit.

Bill sponsor Marsha Haefner (R-St. Louis) said extended treatment has been proven necessary for success.

“Opioid and substance abuse during pregnancy is on the rise, with opioid use during pregnancy mirroring that of the general population,” said Haefner.  “The current time offered for substance use disorder treatment, which is 60-days for these new moms, does not allow for enough treatment for most women to experience success with recovery.  If a new mom is doing well then loses support and treatment for her abuse she will often relapse.  Another risk of pulling treatment too soon is after a period of non-use, women experience an increased risk of overdosing because their tolerance is low.”

HB 2280 was combined with similar bills filed by Representatives Cora Faith Walker (D-St. Louis), Martha Stevens (D-Columbia), and Jay Barnes (R-Jefferson City).

Stevens told lawmakers she was glad that the bill will cover a full range of treatments.

She said that one thing that came out of the committee hearing on the bill was that, “new moms need not just substance use disorder treatment.  That we really need to have comprehensive, wrap-around services, and so I’m very pleased that this bill is full Medicaid coverage so that these new moms can get substance use disorder treatment, they can get mental health care, they can go see a primary doctor, and really support them that first year after giving birth.”

Representative Faith Walker commended the lawmakers involved in the legislation for the bipartisan effort that led to its passage.

“It is a very common sense, evidence-based approach to dealing with the opioid epidemic here in the State of Missouri and it will both save taxpayer dollars as well as save lives,” said Faith Walker.  “I want to encourage the body to look at this effort that was put forward by all the bill sponsors moving forward for the rest of the session.”

Representative Keith Frederick (R-Rolla) said the bill represents something the legislature should do to help the most vulnerable in the state.

“The bottom line is that if we have ladies that are pregnant and have the struggle of addiction, they are in a special, vulnerable situation, as is their child,” said Frederick.

The bill’s projected cost is more than $4-million dollars through 2021, but Haefner noted it would save the state money that would have gone to caring for children who could go to state care if their mothers aren’t afforded treatment, and other cost avoidance.  She said the budget the House is debating this week also includes money to pay for the projected costs to extend this coverage.

The bill has been sent to the Senate for its consideration.  If it becomes law, the state will have to seek a waiver from the federal government to allow for the program to be created and implemented.  Missouri would be the first state to seek such a waiver.

Haefner is hopeful the state could get an answer from the federal government by the beginning of 2019.

House asked to back needle exchanges to stem potential disease outbreaks

Members of a House Committee have been told a bill to exempt needle exchange programs from drug paraphernalia laws could help combat a potential outbreak in intravenous diseases like HIV and Hepatitis C.

Representative Holly Rehder (photo; Tim Bommel, Missouri House Communications)

Representative Holly Rehder (R-Sikeston) told the Special Committee on Urban Issues that abusers who take advantage of needle exchange programs are five times more likely to enter treatment programs.

The committee also heard that the Centers for Disease Control have identified 10 counties in Missouri where conditions could lead to an outbreak like that in Scott County, Indiana.  In that county of more than 24,000 people, 227 became infected with HIV in 2015 and 2016 due largely to sharing needles used to abuse intravenous drugs.

“This bill is to, honestly, sanction existing programs that we have running in the state,” Rehder told the committee about her bill, House Bill 1620.  “Right now we have syringe access, or needle exchange which it is also called, running in the St. Louis area and the Kansas City area.  These have been ongoing for some time but the problem is that they’re running in a somewhat grey area because Missouri’s law has a paraphernalia charge that could be charged.  The local jurisdictions have not pressed that because they see the good in these programs.”

Chad Sabora is a former prosecutor who became a heroin user, and is now an activist in fighting heroin addiction.  He runs one of the needle exchange programs operating in Missouri, which he said won’t stop an outbreak but is a “crucial piece of the puzzle.”

“80-percent of the people that use my syringe access program I put into treatment within three months, because as Holly stated it’s early engagement,” said Sabora.  “They walk into my office seeking clean needles and nothing else, and what they get is something different. They get conversation, they get compassion, they get treatment resources that they did not know exist, and once they find out that all these options are available for them most of them reach out for help, and I never would have told them about those options if they didn’t walk into my office just to get that clean needle that day.”

The committee heard needle exchange programs could also save the state money.  Rehder told the committee the cost to treat HIV patients on Medicaid is expected to increase this year because of changes to the Medicaid program.

Sabora told the committee that a rule change by the Department of Social Services means that anyone with Medicaid can receive treatment for Hepatitis C.

“Before that passed, when it was only the very limited few that got Medicaid treatment, the state still spent upwards of $80-million in 2014.  We can reduce these infections, we can reduce future cost of treatment, and lower the cost to the state,” said Sabora.

Rehder has led legislative efforts in recent years to pass a statewide drug monitoring program to help fight opioid abuse, and has shared how opioid addiction struck her family; her daughter became addicted to opioid painkillers after being treated for a cut she suffered at work.  Rehder said she sees this as another tool to fight opioid addiction.

“We’ve got to be sure that we move emotion to the side and actually look at the numbers, look at the statistics – what’s working?” said Rehder.  “When people first hear about needle exchange one of the first things they say is that’s enabling a user, but you have to look past that.  You have to look beyond the stigma of addiction and you have to see, ok but what helps?  What works?  What gets better outcomes?”

Rehder said if her bill passes to remove the “gray area,” she believes needle exchange programs will spread to other parts of the state including the counties flagged by the CDC.

“There are some federal dollars that we’re passing up right now because we don’t have in statute that these are clear of any gray area, so once we get this passed these individual health departments or individual needle exchanges can reach out to get some of that help in some of these more underserved areas,” said Rehder.

The committee voted unanimously to pass HB 1620.  It next goes to the House Committee on Rules.