Public Health Committee

JOINT FAVORABLE REPORT

Bill No.:

HB-5053

Title:

AN ACT INCREASING ACCESS TO OVERDOSE REVERSAL DRUGS.

Vote Date:

2/24/2016

Vote Action:

Joint Favorable Substitute

PH Date:

2/16/2016

File No.:

SPONSORS OF BILL:

Rep. Sharkey,

Rep. Aresimowicz

Sen. Looney

Sen. Duff

REASONS FOR BILL:

The bill would require local municipality's to amend their emergency service plans. The amendment would postulate that each emergency medical responder in a primary capacity, be equipped with opioid antagonists. The fundamental responders who will be furnished with the opioid antagonists will first receive training on the proper administration of opioid antagonists. This required training will be approved by the Commissioner of Public Health.

RESPONSE FROM ADMINISTRATION/AGENCY:

Deputy Commissioner Nancy Navarretta, MA, LPC, Department Of Mental Health And Addiction Services (DMHAS): The bill improves upon two other raised and passed Governors bills from previous sessions. DMHAS is in support of the requirement for all local municipalities to change their emergency medical service plans. DMHAS is also in favor of the prevention of commercial health carriers requiring any prior approval of naloxone. If supportive action was taken on this bill, there would be a drastic reduction of overdoses within Connecticut.

DMHAS provided substitute language as follows;

(c) A licensed health care professional may administer an opioid antagonist to any individual to treat or prevent a drug overdose without being liable for damages in a civil action or subject to criminal prosecution for administering such opioid antagonist. A licensed health care professional who administer an opioid antagonist is accordance with the provisions of the subsection shall be deemed not to have violated the standard of care for such licensed health care professional.

(e) Not later than January 1, 2017, each municipality shall amend it local emergency medical services plan, as described in section 19a-181b, to ensure that the municipality's primary emergency medical services provider is equipped with an opioid antagonist and it personnel has received training, approved by the Commissioner of Public Health, in the administration of opioid antagonists.

Commissioner of Consumer Protection Jonathan A. Harris, Department of Consumer Protection (DCP): Connecticut is in an epidemic state from the “abuse, misuse, and addiction” to drugs, “such as heroin or prescription pain medications”. State that DCP is currently working to create and apply procedures to fight against drug addiction and misuse within the State of Connecticut.

DCP has been working through the past years overseeing the Prescription Monitoring Program (PMP) in which they have seen vast advancement with combating of prescription drug misuse. The program has two systems in place to help combat prescription drug misuse. One addition is a detection tool that can help to identify at risk patients for drug misuse. A second addition is an instrument that requires all physicians to review patient's history, prior to writing prescriptions. Within the last year DCP developed training and implemented a program that allows pharmacists to prescribe the naloxone drug. There are over 130 pharmacists thus far who have utilized this training program. Furthermore, DCP is also providing pharmacies with information and resources to help those with addiction. They are working throughout the State, to create programs for drop-boxes, so that prescription drugs can be safely disposed of. As a result of this program, over twenty-one thousand pounds of prescription medications have been safely disposed of.

Commissioner Raul Pino, M.D., M.P.H. Department of Public Health (DPH): These drugs can be life-saving. Opioid reversal drugs are not a replacement for needed addiction services such as treatment, but they could be a vital resource to aid towards addition recovery.

DPH has conducted research that shows each year over a two year period (2012-2014) paramedics have needed to use naloxone. Statutory authority has recently been given to non-medical personnel, such as CT State Troopers, to allow them to administer naloxone. DPH is in support of the Governor's proposal as they recognize that there are many different first responders within the state who should be equipped with naloxone.

DPH has provided substitute language as follows;

(c) A licensed health care professional may administer an opioid antagonist to any individual to treat or prevent a drug overdose without being liable for damaged in a civil action or subject to criminal prosecution for administering such opioid antagonists. A licensed health care professional who administers an opioid antagonist in accordance with the provisions of this subsection shall be deemed not to have violated the standard of care for such licensed health care professional.

(e) No later than January 1, 2017, each municipality shall amend it local emergency medical services plan, as described in section 19a-181b, to ensure that the municipality's primary emergency medical services provider is equipped with an opioid antagonist and it personnel has received training, approved by the Commissioner of Public Health, in the administration of opioid antagonists.

State of Connecticut Insurance Department: The Insurance Department has examined major health carriers in Connecticut and confirmed that all include opioid antagonists without a prior approval.

“Section 1311 (d)(3)(B) of the Affordable Care Act permits a state to require Qualified Health Plans (to be sold through Exchange) to offer benefits in addition to the Essential Health Benefits already selected by Connecticut, but it requires the state to defray the cost of these additional benefits.”

“The Department of Health and Human Services (HHS) issued a final rule on February 25, 2013 that recognizes only those mandated benefits that were enacted on or before December 31, 2011 to be considered part of the Essential Health Benefits.” Ultimately the State would not incur the cost of treatment as there is no change in language in this proposal; that would require the State to do so.

The Insurance Department has spent the last 12 months working with different agencies and insurance carriers to secure that the drug will be covered. They have “assisted in drafting PA 15-198” which spoke on insurance coverage for opioid antagonists prescribed by pharmacists.

The department did not provide substitute language but, noted they agree on the language provided previously by DMHAS and DPH.

State of Connecticut Department of Children and Families (DCF): Have seen a drastic rise in heroin use within the cases they acquire. In the last seventeen months the Connecticut State Police have used opioid antagonists successfully in over 60+ cases with positive results. By making this drug more widely available throughout the State, those lifesaving case numbers can only raise.

In the previous year the Governor directed the Alcohol and Drug Policy Council (ADPC) be reconstructed to battle against the epidemic of addiction within the State. With the approval of Governor Malloy they have examined the following areas and feel that the implementation can only improve the current state of Connecticut's drug and alcohol addiction pandemic.

DCF hopes to enact the use of treatment programs such as Medical Assisted Treatment, and other programs to aid against addiction. A collaborative effort is needed between medical personnel, law enforcement, state and local agencies, parents and teachers to making greater awareness about addiction and addiction services. Ultimately DCF would like to see naloxone provided more widely, at an affordable cost, with the proper education.

State of Connecticut, Senator Leonard A. Fasano Senate Minority Leader: The need to fight the addiction and overdose issues within the State. There have been large numbers of casualties over the last 3 years related to opioid overdoses across the State of Connecticut. Bringing overdose reversal drugs to all areas of the states could drastically drop the number of casualties.

The answer to this epidemic is to form “bipartisan working groups” with all applicable government offices, to determine the demands of the community as it relates to opioid overdoses. The Alcohol and Drug Policy Council has not done enough to combat the issues facing the state, and the scheduled meetings of four times throughout the year are not enough to make the necessary changes. A specific group dedicated to the opioid epidemic specifically would be key.

First Selectman Rudy Marconi, Town of Ridgefield: The First Selectman stresses the importance that all first responders have access to Naloxone, as it is a medication that can reverse fatal drug overdoses. In addition to the aforementioned statements, the First Selectman of Ridgefield states that the State of Connecticut State Police Narcotics Task Force needs an increase in funding. It is necessary for Connecticut to establish the Connecticut Director of Drug Policy.

NATURE AND SOURCES OF SUPPORT:

Shawn M. Lang, Deputy Director, AIDS CT: Is in strong support of the bill, as it expands access to Naloxone and strengthens the state's response to opiate addiction.

Pamela Mautte, Director, Greater Valley Substance Abuse Action Council: Urges legislators to support the passage of the bill due to the number of first responders who lack access of Naloxone.

Richard Hart, Uniformed Professional Firefighters Association of Connecticut: On behalf of the Uniformed Professional Firefighters Association of Connecticut, Richard Hart supports this legislation. Mr. Hart states that with the increased availability of Naloxone first responders in Connecticut will be able to reverse the effects of opioids within a shorter time period.

Mary Jane Williams Ph.D., RN, Connecticut Nurses Association: Supports the bill because of the increase in deaths due to opiates. She stresses that drug abuse is a multifaceted issue that cannot be addressed with just one change in legislation, but many. The supporter of the bill believes that this legislation is a great first step in addressing the opioid problem.

Lori J. Pelletier, President, Connecticut AFL-CIO: Ensuring that all first responders have access to Naloxone is essential in alleviating the burden of all unnecessary deaths within the community due to opiate use.

The Connecticut Association of Health Plans: Supports the bill to increase the access of Naloxone to reverse opiate overdoses in Connecticut.

The Connecticut Conference of Municipalities (CCM): Supports increasing access to overdose reversal drugs, such as Narcan. Although CCM is in favor of the legislation, they ask for financial assistance to fund the distribution of Narcan to first responders.

NATURE AND SOURCES OF OPPOSITION:

Gregory B. Allard, Vice President, American Ambulance Service, Inc.: Opposes the legislation, because the local Emergency Medical Services plan can be adjusted to include a Naloxone component.

Reported by: Ashley M. McMann Assistant Clerk

Date: 02/26/16