4/10/2016. Legal & Policy Approaches to Reducing Opioid Poisonings. Overview. Background. Health Directors Legal Conference April 19, 2016

Transcription

1 Legal & Policy Approaches to Reducing Opioid Poisonings Health Directors Legal Conference April 19, 2016 Corey Davis Network for Public Health Law Overview Fatal opioid overdose is at epidemic levels Many overdose deaths can be prevented Reducing inappropriate prescribing and use Reversal of OD w/ naloxone Evidence based TX Law, regulation, policy can make problem better or worse NC has made several changes to improve OD response Background 1

2 Background Background 8 7 Opioid Sales KG/10,000 Opioid Deaths/100,000 Opioid Treatment Admissions/10, Rate Year Overdose Prevention Continuum Reducing improper prescribing Non-opioid therapy Prescriber and dispenser education Modification of insurance incentives Enforcement efforts against pill mills and manufacturers Use of PMPs with best practices Maybe put some industry execs in prison? Addressing addiction Patient education Increased $ and insurance coverage for evidence-based treatment Acknowledgement of addiction as medical condition Bans on demonstrably ineffective tx Jail diversion Improving access to overdose care Increased naloxone access for: community members first responders Good Samaritan 911 legislation Law enforcement education Community education 2

3 Prescription Monitoring Programs (PMPs) States with PMP Enabling Legislation Total Number of States (and DC) Existing PMP legislation New PMP legislation 3

4 OD risk factors 100% 90% 80% one doctor, high dose multiple doctors, high doses 70% 60% 50% 40% one doctor, lower dose 30% 20% 10% 0% patients receiving opioid pain relievers patients overdosing with opioid pain relievers PMP Logic Model 1. Create and populate database 2.??????? 3. Overdose deaths go down 4

5 Quick PMP Thoughts Need to: Ask the right questions what goes into #2? What happens after the clinician checks the PMP? Who can view PMP data, and for what purposes? How does the PMP interact with other systems? Properly train providers Fund evidence-based tx, and easy way to link people to it What is the role of public health? CSRS Changes SB22 Veterinarians become required reporters Reporting window reduced to 3 business days ( encouraged to report w/i 24 hours) Method of payment reportable Physician dispensed supply >48 hours reportable Proactive reports may be issued to prescribers and licensing agencies Delegation permitted Law enforcement access increased Penalties for improper access increased Naloxone Access Laws 5

6 What is Naloxone? Prescription medication Not a controlled substance No abuse potential Extremely good risk profile Reverses opioid overdose Barriers to Naloxone Access Prescribers in short supply Physician visits can be prohibitively expensive Bystanders often fail to summon first responders First responders do not always have naloxone Legal environment overview Prescribing naloxone to own patient is fully consistent with state and federal law Risk of liability no higher than with any other medications, and likely lower than some Many states have passed laws increasing access and reducing liability risk However, prescription requirement and cost remain significant barriers 6

7 State response 43 states have modified law to increase access to naloxone in at least one of several ways: Permit prescriptions to third parties Permit prescription and dispensing by standing or protocol order Provide civil and professional immunity to prescribers, dispensers, and administrators Permit lay dispensing and administration Provide protections for Good Samaritans who report overdose Expand first responder scope of practice to include naloxone NC law: Naloxone Prescribers may prescribe naloxone to a person at risk of overdose or any other person in a position to assist a person at risk of experiencing an opiaterelated overdose. Prescribers may prescribe naloxone via standing order Bystanders may administer naloxone All parties acting as authorized by law are immune from civil or criminal immunity so long as they act in good faith and exercise reasonable care NC law: Good Sam Limited criminal immunity (prosecution) to any person who seeks medical assistance in good faith for person experiencing drug overdose Possession of small amounts of drugs Possession of drug paraphernalia Probation/parole violations Must remain with victim until help arrives Must give name when seeking help 7

8 NC law: Misc. Law enforcement may carry and administer naloxone under authority of county EMS Public health nurses may dispense naloxone under standing order Narcan and generic injectable on Medicaid PDL; Evzio non PDL States with naloxone access and overdose Good Samaritan laws States with naloxone access laws only 45 Number of states with nlx access laws Good Sam Naloxone

9 Conclusion Overdose is a largely preventable and treatable medical emergency Both PMPs and naloxone access laws may be part of the solution No magic bullets coordinated, evidence based approaches are necessary Robust research and evaluation are sorely needed Public health must be more involved Conclusion Every system is perfectly designed to produce exactly the results it s producing. Questions? Corey Davis, JD, MSPH, EMT B cdavis@networkforphl.org 9