LOADING AWESOME
OPIOIDS IN AMERICA:
Calls to Action
LOADING AWESOME
Texas Legislative Council
Part 4:
The State of Texas
Part 3:
Calls to Action
Part 2:
Economic and Social Consequences
Part 1:
A National Crisis
OPIOIDS IN AMERICA:
Calls to Action
Texas Legislative Council
Part 4:
The State of Texas
Part 3:
Calls to Action
Part 2:
Economic and Social Consequences
Part 1:
A National Crisis
Opioids in America
As America's opioid crisis has worsened, both public and private sector entities have taken steps to address the crisis through such means as legislative appropriations and grant programs and policies designed to save lives, expand access to care, and address the behavior of abusers.
This installment of TLC's Opioids in America series will examine some of those efforts in detail.
Opioids in America
Much of the action taken at the federal level has come in the form of appropriations to the states, led by two overwhelmingly bipartisan measures passed by Congress in 2016.
The 21st Century Cures Act appropriated more than $1 billion for grants over a two-year period to help state-led efforts to combat opioid abuse. The Comprehensive Addiction and Recovery Act provided additional grant funding to expand and strengthen prevention, therapy, and treatment programs.
The federal Centers for Disease Control and Prevention (CDC) also operates the Overdose Prevention in States program, which provides states with resources through three separate grant programs created to improve data collection and prevent opioid abuse.
Opioids in America
Initially the opioid crisis centered around the abuse of prescription painkillers. Federal, state, and private-sector entities responded by implementing limits on the amount of medication a prescription could cover.
Medicare Part D has established a seven-day initial prescription limit, as have pharmacy benefit management organizations Express Scripts and CVS Caremark and the nation's largest retail chain, Walmart. Numerous state health plans have limits on initial prescription fills as well.
Thirty-three state governments have enacted some form of prescribing limits with the goal of curbing the supply of prescription opioids and decreasing the number of patients who may form an addiction.
Opioids in America
Thirteen states have implemented laws regulating pain management clinics, with a special emphasis on "pill mills"–pain management clinics that many authorities believe have helped fuel opioid abuse by routinely prescribing powerful narcotics with little medical professional oversight or without demonstrated medical need.
Florida was the first state in the nation to specifically target pill mills. A study on the impact of its regulatory measures found such measures were associated with a significant relative reduction in prescription opioid utilization among patients deemed at high risk for abusing.
Opioids in America
Most commonly, state governments have addressed the abuse of prescription opioids by establishing prescription drug monitoring programs (PDMPs) that electronically monitor prescribing and dispensing data to help deter the over-prescription of drugs. All 50 states and the District of Columbia have implemented such programs.
There is limited evidence that PDMPs lead to a reduction in overall opioid prescriptions or that they have affected the overall rate of overdose mortality. However, a number of states with mandatory, robust PDMPs have experienced significant reductions in prescription opioid dosages and the number of opioid prescriptions filled.
Mandatory PDMPs have also been shown to be associated with decreased foster care caseloads by reducing the number of child removals by 10 percent.
Opioids in America
States have also adopted policies designed to save the lives of abusers and help them receive treatment for opioid dependency. The most common such policy is expanding access to Naloxone, a drug that reverses the effects of opioid exposure and can prevent an overdose death.
All 50 states and the District of Columbia have adopted legislation broadening access to Naloxone, which has been found to be associated with a 14 percent reduction in opioid overdose deaths.
Opioids in America
Forty-five states and the District of Columbia also have "Good Samaritan" protections in place to help facilitate timely lifesaving assistance when overdoses occur.
These protections allow an individual at the scene of an overdose to call for help and await the arrival of emergency services without fear of arrest or prosecution for possession of drugs or related paraphernalia.
A study on the impact of Good Samaritan laws found that such laws are associated with a 15 percent reduction in opioid overdose deaths.
Opioids in America
Medicaid is a key provider of a variety of services directed toward substance use disorders, including opioid abuse and dependency.
Inpatient only
Outpatient only
Both
Neither
Medicaid programs in 44 states and the District of Columbia provide qualifying adults with coverage for drug detoxification treatment through inpatient programs, outpatient programs, or both.
Opioids in America
Coverage under state Medicaid programs for the three federally approved medications used to treat an opioid use disorder vary as well:
49 states and the District of Columbia cover Naltrexone, a drug used to prevent relapse after an opioid addict has been detoxified; and
36 states and the District of Columbia provide coverage for Methadone, a drug that prevents opioid withdrawal symptoms while also reducing cravings.
All 50 states and the District of Columbia provide coverage for Buprenorphine, a drug used to curb cravings for other, more addictive opioids;
Opioids in America
The opioid epidemic has shifted in recent years toward illicit drugs, including heroin and synthetic opioids. Accordingly, more cities across the nation are implementing syringe and needle exchanges to reduce the spread of HIV, hepatitis C, and other infectious diseases that are often spread by needle sharing during intravenous drug use.
These exchanges also provide a means to offer abusers information about available drug counseling and treatment programs.
More than 330 such exchanges are in operation in 2018, a dramatic increase over the 204 exchanges known to be in operation in 2013.
Opioids in America
At the local level, authorities have sought to avoid the expense of incarceration and to reduce recidivism rates by routing opioid abusers into drug courts to help ensure that individuals struggling with addiction gain access to treatment programs.
In 2017, the city of Buffalo, New York, opened the nation's first opioid-specific drug court. As part of the program, eligible offenders are diverted from the criminal justice system into inpatient and outpatient drug-treatment programs, where they receive one-on-one counseling and regular drug testing. Only one of more than 200 participants has suffered an overdose death as of February 2018.
The New York City borough of the Bronx opened a similar court dedicated specifically to opioid abusers in January 2018.
Opioids in America
As opioid-related costs have stressed city, county, and state budgets in recent years—a situation explored —governments have begun looking for ways to recover the billions of dollars spent due to increased incarceration and healthcare utilization and to fund treatment programs.
National attention has also been focused on the courtroom, as hundreds of lawsuits have been filed against opioid manufacturers for deceptive trade practices and other alleged illegal acts in their marketing of potentially addictive drugs.
Twenty-six state governments have filed such suits, as have more than 40 federally recognized Indian tribes. A federal district court judge in Ohio is overseeing a multi-jurisdiction lawsuit combining more than 400 individual suits. The nation has not witnessed a similar movement in search of legal remedies to a public health crisis since the profusion of litigation against tobacco companies in the 1990s.
in the second installment of this series
Opioids in America
TLC's Opioids in America series has examined the scope of the nation's opioid epidemic, as well as the numerous steps taken to address its human costs and socioeconomic impact. The fourth and final installment of the series will focus on how the epidemic is unfolding in the State of Texas.
Opioids in America
https://www.asam.org/resources/publications/magazine/read/article/2016/12/07/the-21st-century-cures-act---highlights-for-asam-members
https://www.asam.org/advocacy/issues/opioids/summary-of-the-comprehensive-addiction-and-recovery-act
https://www.cdc.gov/drugoverdose/states/index.html
https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2018-Fact-sheets-items/2018-04-02-2.html
http://avalere.com/expertise/life-sciences/insights/limits-on-opioid-prescriptions-are-becoming-more-widespread
https://www.npr.org/sections/thetwo-way/2018/05/08/609442939/walmart-will-implement-new-opioid-prescription-limits-by-end-of-summer
https://onlinelibrary.wiley.com/doi/abs/10.1002/pds.4404
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http://ftp.iza.org/dp11470.pdf
https://doi.org/10.1016/j.addbeh.2018.03.014
https://www.macpac.gov/publication/behavioral-health-state-plan-services/
https://www.kff.org/medicaid/state-indicator/states-reporting-medicaid-coverage-of-medication-assisted-treatment-mat-drugs
https://www.nytimes.com/interactive/2018/04/27/upshot/charleston-opioid-crisis-needle-exchange.html
http://ww2.nycourts.gov/sites/default/files/document/files/2018-03/A18_SOJ-Speech.pdf
http://ww2.nycourts.gov/sites/default/files/document/files/2018-05/PR18_01.pdf
https://www.nytimes.com/2018/03/05/health/opioid-crisis-judge-lawsuits.html
For questions, please contact Logan Moore in the TLC Policy Issue Research Section at (512) 463-1155
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