Public Health Committee

JOINT FAVORABLE REPORT

Bill No.:

SB-352

Title:

AN ACT CONCERNING PRESCRIPTIONS FOR AND THE DISPENSING OF OPIOID ANTAGONISTS.

Vote Date:

3/21/2016

Vote Action:

Joint Favorable Substitute

PH Date:

3/7/2016

File No.:

SPONSORS OF BILL:

The Public Health Committee

REASONS FOR BILL:

To allow pharmacists with a standing order to prescribe opioid antagonists in the form of a nasal spray, to individuals or caregivers of individuals who may suffer an opioid related overdose.

RESPONSE FROM ADMINISTRATION/AGENCY:

Jonathan A. Harris, Commissioner, The Department of Consumer Protection (DCP): The Department of Consumer Protection has been involved in preventing drug related abuse in the State. This is a challenge that faces all walks of life, and all income classes. DCP has been working closely with the Governor's Office to combat this issue and to come up with solutions like expanding the “Naloxone Program” throughout the State. This program is similar to one used in California, which allows pharmacists once trained and certified to prescribe Naloxone. The program also trains pharmacists to connect individuals with addiction services. There are currently 140 pharmacists trained under the program. “Senate Bill 352 would maintain the pharmacist prescribing model, but would also add a 'standing order' model to our statutes which would allow a physician to issue a written order to licensed pharmacists to dispense Naloxone to any person who requests it.” As with most countries the United States requires a prescription for Naloxone despite its ease of use. It must be noted that although considered “over the counter”, this bill will still require a prescribers written order. While DCP wanted to support the bill, until changes are made the department cannot do so at this time.

Miriam Delphin-Rittmon, Commissioner, The Department of Mental Health and Addiction Services (DMHAS): While the Department of Mental Health and Addiction Services applauds the combined and aggressive efforts to combat the opioid epidemic in Connecticut, DMHAS feels that this bill is unnecessary at this time. The Department of Consumer Protection (DCP) is already working on a program to certify pharmacists to prescribe Naloxone. DMHAS has also previously provided 70 training sessions on naloxone, attended by 1225 police, treatment providers, families and community members. DHMAS has every intention to continue forward with these trainings. DHMAS has also provided every patient leaving Connecticut Valley Hospital with a naloxone distribution kit upon discharge if they were admitted for opioid addiction related medical issues. While DHMAS understands the importance of the bill, in the opinion of the department it is not necessary at this time to pass such legislation.

Representative Melissa Ziobron, Thirty-Fourth Assembly District: Addiction is not something new within Connecticut, and it affects people of all areas of the State. Specifically speaking on those residents who suffer from addiction problems in the thirty-fourth district, many stories have come through about current and past addiction problems from constituents. Currently Nathan Hale Pharmacy in Moodus is in the process of securing the ability to prescribe naloxone. The ability to prescribe the nasal spray version of naloxone would be the best possible result of this bill, as it is the easiest to administer in a time of crisis, like an overdose. It would also allow those with or without insurance to have access to the lifesaving drug. The passing of this bill can only help the residents of Connecticut currently suffering from addiction.

NATURE AND SOURCES OF SUPPORT:

Connecticut Hospital Association (CHA): Connecticut hospitals are working on efforts to reduce opioid related addictions and abuse. The Connecticut Hospital Association has partnered with other departments and organizations throughout the state to provide education related to opioid abuse. This bill will provide a multi-sector collaboration effort which will aid in the combating the misuse of opioids and other prescription medications.

Connecticut State Medical Society (CSMS): The Connecticut State Medical Society supports the bill, citing that the drafted bill acknowledges the differences between injectable antagonists from other alternatives, like the nasal spray. Also, the drafted bill will only allow pharmacists to prescribe the antagonist under a standing order. The concern comes from the fact that, while the nasal spray is easier to use, has risks associated with it that may not have been acknowledged. The greatest concern is only treating the sudden symptom, and not the underlying addiction issue. CSMS requests that “this committee support out suggestion that all stakeholders be involved in developing a single comprehensive piece of legislation that includes education, prevention and an increased commitment of resources for treatment in addition to simply focusing on end-stage salvation options.”

Shawn Lang, Deputy Director, ACT AIDS Connecticut: “From 2009-2014, there were over 2,000 accidental and unintentional opioid involved deaths that occurred in 150 of our 169 cities and towns.” Research has that been conducted and found that while not all opioid abusers become addicted to heroin, many are more likely to use heroin after becoming addicted to opioid medications. ACT has provided training to its clients who participate in the syringe exchange program, on how to recognize signs and symptoms of an overdose, and how to administer lifesaving antagonists. This training has been used over 60 times to help save lives in overdose situations in the Hartford community. By enacting this bill, it will bring Connecticut into line with other states that have already taken this type of step to combat opioid abuse.

Theresa Doonan, Resident Trumball Connecticut: Coming forward as the mother of a son, who died from a heroin overdose, and giving strong encouragement for the passing of this bill. As an advocate for many families in the Trumball area, and working to find programs for individuals who are suffering from opioid and heroin related addictions it should be noted that Connecticut is severely behind the times and trends of other states concerning their opioid abuse legislation and assistance. This is in regards to, having had to experience the pain of losing a child to this type of addiction, and urging the swift passage of this legislation is necessary.

NATURE AND SOURCES OF OPPOSITION:

Margherita Giuliano, Connecticut Pharmacists Association (CPA): It is the understanding of the CPA that the purpose of this bill is “to permit prescribing practitioners to issues a standing order to pharmacists to permit them to dispense an opioid antagonist in a nasal form to a person without patient specific prescription.” This is a concern to the CPA as; there is no need to over complicate a process that is already in place. As it currently stands a pharmacists does not need a standing order to prescribe an opioid antagonist. In section 1 (b) the language states that a pharmacist who agrees to accept a standing order issues under subsection (a) of this section and dispenses an opioid antagonist in accordance with the provisions shall be deemed not to have violated any standard of care for a pharmacist. No standard of care is impacted since nowhere is the dispensing function delegated in health care law. There is no need to have a standing order for a drug of this nature. There are already programs in place that have started the process of certifying pharmacist to prescribe antagonists. The passage of this bill is unnecessarily adding to the bureaucratic process, and taking away from the positive steps of the Governor's office to combat opioid addiction.

Reported by: Ashley McMann

Date: 03/31/16