As the rates of opioid overdoses increase across the nation, newly announced proposals for state legislation aim to reverse this trend in Connecticut.
Gov. Dannel Malloy will propose legislation later this month to address abuse of prescription opioids and heroin. The new policies will include better utilization of the state’s prescription monitoring program, improved education for physicians prescribing opioids for pain relief and increased access to overdose-reversing drugs.
“This legislation will give providers the tools they need to help save lives,” said Lieutenant Gov. Nancy Wyman in a press release. “Reducing the potential for addiction — and identifying dangerous behavior — is key to intervention.”
The legislation aims to improve the Connecticut Prescription Monitoring and Reporting System, a database to which pharmacists and physicians who dispense medication submit prescription information. Under the proposed legislation, prescribers would be required to check the database before prescribing a patient more than a 72-hour supply of a medication to ensure that the patient is not receiving the same medication from other prescribers.
With the current system, prescribers are only required to enter data on a weekly basis — the proposed legislation would change the requirement to daily reporting. Real-time updates would allow pharmacists and physicians to make an informed decision on whether to prescribe a controlled substance to a patient, said Xaviel Soto, program manager of the state Prescription Monitoring Program, in an email. He added that changing pharmacies’ systems to allow for real-time reporting might pose a challenge.
“As with any oversight, it will require due diligence by physicians and pharmacists working together,” Soto said.
Under the proposed legislation, the Alcohol and Drug Policy Council — composed of members of relevant government departments and selected outside experts in its previous iteration — would be reinstated and again play a role in shaping policy regarding addiction. The legislation will also include provisions to improve education for doctors on issues related to prescription drug abuse as part of the licensing process. That aspect of the legislation is especially important, said Robert Heimer GRD ’88, professor of epidemiology and pharmacology at Yale. General practitioners with insufficient training in pain management should not be prescribing opioids and should be referring patients to specialists, he said.
The new legislation will also include new policies to make naloxone, a drug that can reverse an overdose, more accessible by allowing certified pharmacists to prescribe the drug to people who may, at some point, need to treat an overdose, including families, first responders and drug treatment professionals.
Past legislation has also addressed the accessibility of naloxone in the event of an overdose. In 2012, Malloy signed legislation to provide naloxone prescriptions for people close to those with opioid addictions. In June 2014, he signed legislation to protect bystanders from liability if they intervene with naloxone to reverse an overdose. This legislation will expand upon past provisions.
Although it will not decrease drug use problems, expanded access to naloxone is going to save lives, said Lauretta Grau, associate research scientist in epidemiology.
“I’ve seen how effective, wonderful and lifesaving [naloxone] is,” Heimer said. “Keeping people alive until they’re ready for treatment is the right first step.”
But both Grau and Heimer added that further action needs to be taken to change public and government opinions toward long-term and short-term opioid treatments in order to enact more comprehensive change, including increased funding for addiction treatment and destigmatization of substitution therapies, such as methodone.
Grau cited a troubling conversation with a city police officer regarding opioid overdoses. When she suggested that police officers carry naloxone, the police officer responded that the police are not first responders. While Grau suspects that the argument behind this aversion to carrying naloxone centers on liability and cost issues, she said the argument is holding back government workers from effectively serving their communities.
“The attitudes of people in positions of power need to change,” Grau said.
Connecticut State Police began carrying naloxone with them in October 2014 and have been able to save 13 people from overdoses, according to the press release from the Governor’s Office.
Opioid deaths have been at record-high levels nationally, as well as in Connecticut. According to preliminary data from the Office of the Medical Examiner provided to the New Haven Register, there were 307 deaths from opioid overdoses in 2014, a slight decrease from the 324 opioid overdose deaths reported in 2013. But the trend in deaths from heroin, an opioid, has been on the rise. In 2014, there were 273 overdoses that involved heroin, an increase from 257 heroin-related deaths in 2013 and 174 in 2012.
As heroin continues to play a role in a majority of opioid-overdose deaths, increasing control of prescription opioids might not address the main problem, Grau said. Abuse of pharmaceutical opiates began increasing in the late 1990s and continued until the early 2010s. That turning point, Heimer noted, correlates with the beginning of FDA regulations making opioids more expensive and tamper-resistant. Heroin presents itself as a cheaper black market alternative but is unregulated, resulting in the consumption of unknown quantities of potentially tainted drugs, Heimer said.
“[The proposals] are a step in the right direction, but I don’t know if it is going to have much of an effect on the problem,” Grau said.
There were 18 heroin-related deaths in New Haven in 2014.