Public Health Committee

JOINT FAVORABLE REPORT

Bill No.:

HB-5063

Title:

AN ACT CONCERNING TREATMENT FOR A DRUG OVERDOSE.

Vote Date:

3/23/2012

Vote Action:

Joint Favorable Substitute

PH Date:

3/7/2012

File No.:

SPONSORS OF BILL:

Public Health Committee

REASONS FOR BILL:

To clarify that healthcare professionals may prescribe opioid antagonists to a broad group of individuals for the prevention of drug overdoses.

RESPONSE FROM ADMINISTRATION/AGENCY:

Christian Andresen, Section Chief, DPH: Drug overdose rates have never been higher. According to the Centers for Disease Control and Prevention, overdose deaths were second only to motor vehicle crash deaths among leading causes of unintentional injury deaths in the United States (2007).

Naloxone is standard treatment for preventing an opioid overdose. According to a 2009 study published by the American Medical Association, the peers or family members of overdose victims are most often the actual first responders to a drug overdose, and are best positioned to intervene quickly at the onset of overdose symptoms. Data cited in the study demonstrate that lay persons are consistently successful in safely administering naloxone and reversing opioid overdose.

This bill clarifies that people other than drug users can be prescribed naloxone to prevent drug overdose deaths. For example, a health care professional could prescribe naloxone to a family member of a drug user to administer in the event of an overdose. Access to naloxone in this instance may increase the likelihood of survival for the person who overdosed.

DPH is committed to improving health outcomes of Connecticut residents and therefore supports this bill.

Patricia Rehmer, MSN, Commissioner, Department of Mental Health and Addiction Services (DMHAS): In a study done in Connecticut in 2009, drug overdose was the leading cause of death among 18 to 25 year olds. Drug-induced overdose has been the most common cause of accidental death in Connecticut every year for the past 10 years. During a 3 year period from 2006 to 2008 there were 1256 overdose related deaths (832 males and 424 females) in Connecticut. On average, there is at least one person a day who dies from an opioid overdose in Connecticut. Most deaths occur at home often with other individuals in the house. Most overdoses can be easily reversed if treated promptly.

The current statute allows the drug to be prescribed to individuals suffering from addiction. However, an individual who has overdosed could become unable to self- administer. This proposal would allow family members, significant others, roommates and the like to have Narcan on hand should the situation warrant it.

Narcan works for an opioid overdose like an Epi-pen does when used for an individual with life threatening allergies. It can be administered very simply as a nasal spray. Narcan can be carried in a purse or pocket or put on a nightstand. Narcan has no street value or addictive potential. It cannot give a “high”. If given to someone who is not suffering from an overdose, it may make the individual a little uncomfortable but have no other effect. If it is administered to someone who is using painkillers, methadone or heroin, it can precipitate discomfort due to withdrawal.

Connecticut has a growing addiction problem among all age and socioeconomic groups partially due to easy access to prescription drugs and heroin. We support those that face the challenging and lengthy process of achieving sustained recovery. As part of this effort, we ask you to consider this proposal to allow family, friends, and others to administer Narcan because it will save lives.

NATURE AND SOURCES OF SUPPORT:

A Better Way Foundation: Overdose prevention should be available to people who can assist if they believe someone is experiencing an overdose. A study by the Department of Public Health in 2004 concluded, opioid antagonists, naloxone, appear to be the most promising current intervention strategy to reduce overdose mortality. The study also found the following facts:

● Approximately 73% of unintentional opiate overdose decedents are white, 8% were black, and 18% were Hispanic (of any race).

● Approximately 41% of unintentional opiate and related narcotics poisoning deaths took place in the decedents' home.

● A study by the Yale School of Public Health, found the following facts:

● Sixty-one percent of overdoses involved heroin; the remaining cases involved prescription opioid analgesics such as hydrocodone, oxycodone and methadone, or a lethal combination of the opioids.

● Most deaths were among people 35-44 years old.

● There is an increasing trend of overdoses in older individuals, some in their 50s and 60s

● Of the 169 towns in Connecticut, 147 towns reported a death from overdose from 1998-2009

● There is a high prevalence of overdose deaths in parts of Litchfield, Middlesex, and Windham counties and the state's major urban centers and surrounding communities.

This year, Connecticut should take the responsible next step and allow health care professionals to prescribe opioid antagonists (naloxone) to a broader group of persons for the prevention of drug overdoses.

Mary Walton, MHS, PA-C, Yale AIDS Program: I am a physician assistant and have worked at the Yale AIDS Program for over 10 years. In addition, I worked in an HIV clinic in Florida in the 1980's. During my time at Yale, I ran a mobile health care clinic (the Community Health Care Van) that provided free care to the most marginalized populations in New Haven. Currently, I work at two drug treatment centers in New Haven.

I have worked to train drug users in overdose prevention using Narcan. During these trainings, I heard many stories of how individuals have watched friends and loved ones die of overdose when the ambulance came too late. I also heard uplifting stories of how Narcan in overdose prevention kits has saved lives as well.

Until we as healthcare professionals, case workers, family, and friends, can help reduce drug addiction, Narcan can save lives.

Pamela Mautte, Director, Greater Valley Substance Abuse Action Council (VSAAC): I am the Director of the Greater Valley Substance Abuse Action Council. My Regional Action Council (RAC) oversees alcohol, tobacco, and other drug use prevention efforts within the 11 towns including: Ansonia, Bethany, Derby, Orange, Oxford, Milford, New Haven, Seymour, Shelton, West Haven, and Woodbridge.

In my role as Director, I have heard from many parents, grandparents, spouses, children, and residents who have lost loved ones from opioid overdose deaths.. By passing this legislation, Connecticut can reduce accidental overdoses and prevent overdose deaths in our state. HB 5063 encourages “safe opioid prescribing” by providers, and puts naloxone within safety's reach for those at the highest risk of overdose death.

Thomas McNally, Windam Harm Reduction Coalition: I am co-founder of the Windham Harm Reduction Coalition of Willimantic. I have been involved with opioid users for several years. I have lost some friends and clients who could have been saved with simple injection of Naloxone. Naloxone is not a drug that is subject to abuse and I doubt it will open the door for new abuse. I have several persons who have informed me that Naloxon saved their life.

Auralia Perrica, Treasurer, Windham Harm Reduction Coalition & Christopher Heneghan, Director, Windham Harm Reduction Coalition: Windham Harm Reduction Coalition Inc. works to empower and make a difference in the lives of individuals struggling with drug addiction in Windham County by offering comprehensive harm reduction services, education, and training.

Naloxone is an unscheduled drug with no abuse potential and a very favorable safety profile. It is similar to an Epi-pen which many people use to prevent anaphylactic shock or a glucagon injection for diabetics experiencing severe insulin reaction. Naloxone's only use is to bring someone out of an opioid overdose.

In 2011, the CDC reported the number of deaths from opioid pain relievers to have reached epidemic proportions in the United States. In Connecticut drug overdose is the leading cause of accidental death in adults. It accounts for more fatalities than unintentional deaths due to motor vehicle accidents and firearms combined. Make Connecticut a national leader in averting drug overdose, fighting this epidemic and saving lives.

Melanie Alvarez, Medical Case Manager: I am a Medical Case Manager working with the HIV Population and a citizen in the City of New Britain. Accidental overdose is not just a problem in our cities, or in injection drug users; it is everyone's problem since us tax payers are bearing the financial burden of unnecessary hospitalizations.

In September of 2011, The National Institutes of Health published a study that found that nationwide there was a 122% increase in poisoning due to opioid pain and related medications in youth aged 18-24. In the 18 and older population, there were 1.6 million hospitalizations for accidental overdose, for an overall cost of $15.5 billion. We can save lives and save money for our state by giving people an alternative to death and hospitalization.

From personal experience, I have lost many friends and even a parent to opiate overdose. I grew up in a gated community in the suburbs. My parents were successful small business owners. My father was a person who was clean and in recovery for many years and then one relapse resulted in his death. I believe if there were access to this medication, Narcan, at the time of his death, he may still be alive today.

Shawn Lang, Director, CT AIDS Resource Coalition (CARC): CARC works to ensure that the more than 10,000 people living with HIV/AIDS in our state have the housing, care and supportive services they need in order to live their lives in dignity.

Narcan saves lives. Similar to the Epi-pen that people use to prevent an anaphylactic shock, Narcan's only use is to bring someone out of an opioid overdose. Opioids include heroin, morphine, fentanyl and, oxycodone.

Narcan provides a 30-90 minutes window of opportunity to call 911 and get someone to the emergency room. This action can often make the difference for getting someone into treatment and back on track with their lives.

Traci C. Green, PhD, MSc; Alpert Medical School of Brown University & Robert Heimer, PhD, Yale School of Public Health: Over the past 6 years, our research groups at the Yale School of Public Health and Brown Medical School have been working with the CT Office of the Chief Medical Examiner (OCME) to review records of drug-involved accidental deaths. During 1997-2007, we found that among 2900 drug intoxication deaths, 77% involved an opioid that is, heroin or a prescription opioid.

This public health problem deserves particular attention in Connecticut because of the following facts:

● Drug poisoning overdose is the leading cause of accidental death among adults in CT

● CT is one of 20 states in which mortality from overdose is now more prevalent than deaths from motor vehicle crashes

● Drug-related deaths claimed the lives of one CT resident each day in 2009, with the most common drugs involved in the deaths being opioids like heroin and oxycodone.

● 148 of the 169 CT towns experienced at least one opioid-related overdose death during the period of 1997-2007, with many of the small town and suburban areas seeing increases in prescription opioid-involved overdose deaths.

Most overdose deaths are preventable. Perhaps surprisingly, up to 85% of opioid overdoses occur in the presence of others. Since overdose episodes generally unfold over several hours, overdoses can often be reversed through professional or lay intervention. The standard medical response to an opioid overdose is rescue breathing and the administration of the short-acting opioid antagonist naloxone (trade name Narcan). Recognizing the increasing opioid overdose mortality, many health promotion advocates have been encouraged to develop interventions to reduce overdose incidence.

Joey Adamaitis: I am a concerned citizen from Beacon Falls. I have a B.A. in Computer Graphics and study drug policy in my spare time. I work for LEAP (law enforcement against prohibition), a group of police officers dedicated to ending drug prohibition. I am familiar with Narcan. When I played high school football, my friend overdosed and died. If his mother had Narcan she may have saved her son's life. I have read numerous articles about it and I believe that the people should be able to have it in their possession, just in case an overdose does happen.

Mary Marcuccio: I am a resident of Southington. I am a parent of a 22-year old son with an extensive drug history. It is highly unlikely that my son would administer an opioid antagonist, like Narcan himself if he is overdosing. Currently, if I administer the Narcan shot I am subject to arrest and prosecution for administering a medication without a license. We are asking for opioid antagonists, like Narcan, to be viewed practically and legally, like an Epi-pen.

Robin Clark-Smith: I have worked with substance users for over 15 years. About 10 years ago, one of our clients overdosed in the parking lot. The staff performed CPR, but he quit breathing, turned blue, and coded. Gratefully, the ambulance arrived, and they used Narcan and a defibrillator. He went to the hospital, and was back in our office that afternoon. I will never forget that day. Narcan saved his life. However, there are many other people who died from overdoses, and another one of my clients died last May. Please support this bill and stop these senseless deaths.

NATURE AND SOURCES OF OPPOSITION:

None Presented

Reported by: Peninnah L. Bonhomme

Date: 3/26/2012