Public Health Committee
JOINT FAVORABLE REPORT
AN ACT CONCERNING SUBSTANCE ABUSE AND OPIOID OVERDOSE PREVENTION.
Joint Favorable Substitute
SPONSORS OF BILL:
Public Health Committee
Rep. Sharkey, 88th Dist.
Rep.Aresimowicz, 30th Dist.
Sen. Looney, 11th Dist.
Sen. Duff, 25th Dist.
REASONS FOR BILL:
1. Requires prescribing practitioners, before prescribing greater than a 72-hour supply of any controlled substance, to check the patient's record in the prescription drug monitoring program (PDMP);
2. Requires prescribers to review the patient's record at least every 90 days if prescribing for prolonged treatment;
3. Starting in July 2016, requires pharmacists to immediately report to the PDMP on prescriptions they fill, rather than at least weekly, and requires the reporting to be done electronically;
4. Allows pharmacists to prescribe opioid antagonists (e.g., Narcan), if they receive special training and certification to do so, and extends to them the same immunity that currently applies to other prescribers when prescribing, dispensing, or administering an opioid antagonist;
5. Requires physicians, APRNs, dentists, and PAs to take continuing education in prescribing controlled substances and pain management (as part of existing CE requirements);
6. Makes several changes to the membership of the Connecticut Alcohol and Drug Policy Council; and
7. Adds pharmacists to the definition of “healing arts” in statutes on health care centers (in insurance statutes).
Substitute Language: Technical corrections were made.
RESPONSE FROM ADMINISTRATION/AGENCY:
George Jepsen, Attorney General, State of Connecticut: Supports the bill because it seeks to address one of the most urgent public health issues facing our state and country. Prescription drug abuse is a problem of epidemic proportions. Prescription drugs are now the most abused drugs among 12 and 13 year olds. It is also well documented that those who abuse prescription drugs often switch to heroin, which has become a readily available and cheaper alternative in many of our communities. The bill will increase the access to naloxone and other life-savings opioid antagonists. It will allow pharmacists to include, after being certified and trained by Department Consumer Protection, to prescribe these important drugs.
Deportment of Children and Families (DCF), State of Connecticut: DCF endorses efforts to improve responsible practices contained in sections one through seven of the bill. We know that young persons report easy access to prescription drugs through people giving them extra prescriptions belonging to family or friends, purchasing them, stealing them or abusing their own. The bill will make efforts to make NARCAN available in the community. NARCAN is a proven life-saving medication that has saved the lives of numerous individuals.
Miriam Delphin-Rittmon, Deputy Commissioner, Department of Mental Health and Addiction Services: Implementation of a comprehensive and coordinated statewide strategy that restrict access to these types of prescriptions for illicit use, while ensuring availability for those who legitimately need them will help curb this public health crisis.
Jewel Mullen, Commissioner, Department of Public Health (DPH): According to the Centers for Disease Control and Prevention, over half (51.8%) of the 43,982 drug overdose deaths in the United States were related to pharmaceutical drugs. More than two thirds of the deaths related to pharmaceutical drugs involved opioid analgesics. The strategies contained in the bill will provide an opportunity to reduce the public health impacts of addiction to, and the number of overdose deaths resulting from, opioids.
Jonathan Harris, Commissioner, Department of Consumer Protection: Supports the Governor's proposal to increase practitioners' awareness of proper pain management and their role in prescribing controlled substances through statutory changes in their continuing education requirements. In addition the increase in availability of Naloxone will make it easier for persons who are close to high risk drug dependent individuals to acquire naloxone and be prepared to save the life of a person who has overdosed.
Barbara Henry, First Selectman, Town of Roxbury: This bill provides vital tools to help combat the growing trend of controlled substance abuse. I can attest to the increased number of opioid overdoses our emergency services and police in mutual aid towns deal with on a daily basis. It is imperative to have a strong prevention and education to combat drug abuse. Allowing greater access to opioid antagonist medications should be instituted to coincide with such a comprehensive approach to address substance abuse in Connecticut.
NATURE AND SOURCES OF SUPPORT:
Marghie Giuliano, Connecticut Pharmacists Association: Strongly supports the requirement that prescribing practitioners that are allowed to prescribe controlled substances for the management of pain be required to complete educational activities that provide best practices on the appropriate prescribing of controlled substances and pain management. We do have concerns about the additional costs to the real time reporting to the Prescription Monitoring Program (PMP). We feel that requiring every 24 hours would be more reasonable.
Jeffrey Shelton, MD, Middlesex Hospital: Naloxone saves lives and should be available to Police and EMTs. It has saved 10 potentially fatal overdoses because it was prescribed.
Carrie Rand-Anastasiades, Connecticut Association of Community Pharmacies: We support the bill, but feel that “real-time” reporting is cost-prohibitive, disruptive and will provide little if any additional benefit. We are not opposed to daily reporting with a variance for holidays.
Connecticut Council of Small Towns (COST): The bill permits pharmacists to dispense and administer opioid antagonists such as Naloxone or Narcan in an overdose. The expansion in the availability of these drugs provides for an additional avenue for those in need. It will assist communities as well as emergency responders in dealing with opioid overdoes.
Pamela Mautte, BHcare: The U.S. consumes 99% of all hydrocodone and 80% of all opioids. Current trends highlight that there are a lack of prescribers who can adequately treat pain. A survey of prescribers in Rhode Island and Connecticut found that those who made use of PMP data were more likely than non-users to take clinically appropriate action in response to suspected cases of prescription drug abuse.
Jeff Holland: Pharmacists are in a unique position to help reduce opioid overdose deaths by furnishing Naloxone.
Shawn Lang, AIDS Connecticut (ACT): Between 2009-2014, there were over 2,000 accidental and unintentional opioid involved deaths that occurred in 150 of Connecticut's 169 cities and towns. Nationwide, 18 to 24 year olds are more likely to die from drug overdoses, primarily from prescription pain relievers, than from motor vehicle accidents.
Northeast Communities Against Substance Abuse: Sports the mandated registration and use of prescribers in the Prescription Drug Monitoring Program, the increase availability of Naloxone to first responders and families and increased prescriber education on the proper dispensing and prescribing of these powerful medications. We have concerns about the budget reductions that will harm the ability to do public outreach necessary to advance public knowledge and response to this problem.
Connecticut State Medical Society: The proposed legislation contains several sections with the intent of identifying opioid abuse and preventing opioid misuse and ultimately death from overdose. We have concerns regarding the absence of language to increase resources for and access to substance abuse treatment services. We ask that we address the entire issue of addiction and opioid without placing a burden on those who seek to treat patients in need.
Connecticut Hospital Association (CHA): CHA supports the bill as one component of a comprehensive statewide strategy to reduce the misuse and abuse of opioids and other prescription drugs in Connecticut. Opioids substances can be a safe and effective tool to manage pain, but they may be misused or abused by people seeking their euphoric effect. CHA is prepared to support real-time reporting of certain controlled substance prescriptions to the state Prescription Monitoring Program (PMP), as well as an obligation that prescribers check the PMP before prescribing a controlled substance. CHA recommend that DCP consider the consequences for prescribers and patients in the event that PMP system fails for a period of time and questioned what would be the procedure if the prescribers are unable to check the system.
CT Association for Addiction Professionals: Supports the bill, but would like to stress a Tea approach to prevention, implementation of uniform standards of practice in use of suboxone and additionally addiction is a primary disease and is treatable.
Ingrid Gillespie, Connecticut Prevention Network: This bill exemplifies a multi-strategy approach that supports both prevention and harm reduction strategies. The bill addresses gaps that were reported in 2013 Trust for America's health report.
Jonathan Craig Allen, MD: Shared a story of a opioid overdose. Supports the use of Naloxone because it is non-addictive, safe and can be easily administered.
Gary Mendell, Shatter Proof: Shared personal story of her son Brian who died at 25 years of age due to overdose.
Connecticut Orthopaedic Society: This bill is an important and timely response to the safe and appropriate use of narcotic pain medication prescribed by physicians. Educating and training physicians that prescribe narcotics is vital.
The following 11 people submitted testimony on their personal experience with opioid overdose: Robert Braunstein, Mark Stern, Jill Miller, Lisa Hall, Chris & Deb Bachman, Terri Cutler, Lisa Tedesco, Wade Chartier, Laura Zeppieri and Ada Hines.
NATURE AND SOURCES OF OPPOSITION:
Reported by: Zani Imetovski