fentanyl Archives - Medical Association of the State of Alabama

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U.S. House Passes SUPPORT for Patients and Communities Act

Posted by admin on July 20, 2018

In a 396-14 vote, the U.S. House of Representatives passed the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act, or H.R. 6 —bipartisan opioid legislation that aims to curb drug abuse.

Sponsored by Greg Walden, R-Oregon, the package of legislation contains more than 50 individually approved bills to address what Pres. Donald Trump has called a health emergency.

The SUPPORT bill is intended to fight the opioid crisis by advancing treatment and recovery programs, improving prevention efforts, providing resources to communities and fighting drugs like Fentanyl. The legislation also calls for a review of current opioid prescriptions, development and usage of non-addictive painkillers, making a patient’s addiction history as part of their medical records to prevent relapse and reducing the trafficking of Chinese fentanyl into the country. Additionally, the legislation will expand Medicare and Medicaid-related services to combat drug abuse.

Opposition votes came from 13 Republicans and a lone Democrat. Alabama’s Rep. Mo Brooks voted against the legislation, which is now headed to the Senate for review and passage.

In short, the bill makes several changes to state Medicaid programs to address opioid and substance use disorders. Specifically, the bill:

modifies provisions related to coverage for juvenile inmates and former foster care youth,
establishes a demonstration project to increase provider treatment capacity for substance use disorders,
requires the establishment of drug management programs for at-risk beneficiaries,
establishes drug review and utilization requirements,
extends the enhanced federal matching rate for expenditures regarding substance use disorder health home services, and
temporarily requires coverage of medication-assisted treatment.

The bill also alters Medicare requirements to address opioid use. Specifically, the bill:

exempts substance use disorder telehealth services from specified requirements,
requires the initial examination for new enrollees to include an opioid use disorder screening,
modifies provisions regarding electronic prescriptions and post-surgical pain management,
requires prescription drug plan sponsors to establish drug management programs for at-risk beneficiaries, and
requires coverage for services provided by certified opioid treatment programs.

The bill also addresses other opioid-related issues. Specifically, the bill:

establishes and expands programs to support increased detection and monitoring of fentanyl and other synthetic opioids, and
increases the maximum number of patients that health care practitioners may initially treat with medication-assisted treatment (i.e., under a buprenorphine waiver).

Additionally, the bill temporarily eliminates the enhanced federal matching rate for Medicaid expenditures regarding specified medical services provided by certain managed care organizations.

The Medical Association is closely monitoring the status of this legislation, but we encourage you to read more about the legislation here.

Tags: addiction, community, fentanyl, opioid, support

Posted in: Advocacy

Alabama SB39: Another Shot in the Opioid Battle

Posted by admin on April 5, 2018

On March 28, 2018, Alabama Senate Bill 39 was sent to Governor Ivey’s desk for signature. SB39 introduces stiffer penalties related to fentanyl possession and distribution. It amounts to a local effort forming part of a nationwide, multi-pronged response to the opioid epidemic that has plagued the country in recent years. While this bill is not yet law as of the date of this article, it came to the Governor’s desk with broad support from both the House and Senate, and an awareness of its contents (and its place in the larger opioid crisis) is valuable.

Fentanyl is a particularly strong opioid that has of recent been the target of much abuse. The National Institute on Drug Abuse notes that in 2016, fentanyl contributed to more than 20,000 overdose deaths; medical examiners reported that fentanyl or fentanyl mixtures were involved in the deaths of the musicians Prince and Tom Petty. SB39 includes several related features stiffening enforcement of abuses of fentanyl and related drugs: the bill would:

add fentanyl and related analogues (e.g., butyrfentanyl and acetyl fentanyl) to Schedule I of the controlled substances list;
make a person (unless otherwise authorized by law) who possesses, distributes, or traffics such drugs guilty of a felony, and conviction for distribution subject to enhanced penalties;
include under the meaning of “trafficking” possession of fifty or more individual packages of the substance

A related proposal that was introduced but ultimately rejected by the legislature was a change to allow prosecution of physicians for over-prescribing opioids.

Of particular note are the low thresholds set for amounts of fentanyl and fentanyl analogues — an acknowledgment of both the potency of the drug and the severity of the current crisis. The bill would amend §13A-12-231 of the Alabama Code to make possession of one gram or more of fentanyl or a fentanyl analogue a felony of “trafficking in illegal drugs,” and includes substantial fines. As noted above, conviction can also occur if one is in possession of 50 or more individual packages of fentanyl or a fentanyl analogue, notwithstanding the fact the combined weight of the fentanyl or fentanyl analogues in the packages may be less than one gram.

At this point of the opioid epidemic, some physicians may well be experiencing opioid fatigue. News articles, legislative and regulatory initiatives, personal testimonies, seminar topics, and other avenues have been bringing this issue to the health care industry’s attention for years now. It is a complex problem, with a multiplicity of root causes and a variety of faces. The several penalties included in this recent bill are a reminder that staying abreast of all the many changes, initiatives and tools aimed at addressing opioid abuse is well worth the time and attention.

Whatever the eventual fate of SB39, this will not be the last shot fired in the response to opioid abuse. This bill is a reminder that the responses to this crisis are varied, and that although the opioid epidemic is a national problem, it also plays out on the state and local level. As “opioid” refers to a diverse range of drugs, the “opioid epidemic” refers to a complex quagmire. Being well aware of the problem, in general, is no substitute for familiarity with the many paths being carved through it. In addition to introducing potential changes to the criminal law code such as SB39, Alabama has also taken such steps as forming the Alabama Opioid Overdose and Addiction Council, formed in August 2017 by Governor Ivey, which has made such recommendations as improving and modernizing Alabama’s prescription drug monitoring program; the Alabama Department of Public Health is leveraging funding from the CDC’s Data-Driven Prevention Initiative (DDPI) on Opioid and Heroin Abuse to identify stakeholders of and solutions to the problem; Alabama Attorney General Steve Marshall filed a lawsuit in February 2018 against one of the largest drug manufacturers in the nation.

This is a constantly changing landscape, and the opportunity for missteps abound. Some of these missteps have consequences that reach beyond issues of reimbursement and licensure. The fate of SB39 is worth watching — its wide support in both chambers of the Alabama Legislature make it a prime candidate for signing into law by the governor. However, beyond offering a description of this one bill, this present article should serve as a reminder that opioid-related news deserves close attention because of, not despite, the frequency of the topic. New laws and initiatives are coming out regularly, and if you’ve seen one you have not seen them all.

Article written by Chris Thompson, an attorney with Burr & Forman LLP practicing in the firm’s healthcare group. Burr & Forman, LLP, is a partner with the Medical Association. Read other articles from Burr & Forman LLP.

Tags: death, drug, fentanyl, legislative, opioid, overdose, SB39

Posted in: Legal Watch

Alabama Opioid Overdose and Addiction Council Issues Formal Report

Posted by admin on January 26, 2018

MONTGOMERY — Co-chairs of the Alabama Opioid Overdose and Addiction Council, Attorney General Steve Marshall, Commissioner Lynn Beshear of the Alabama Department of Mental Health, and Acting State Health Officer Dr. Scott Harris, announced the issuance of the Council’s formal report of its findings.

The Council was created in August 2017 by an executive order of Gov. Kay Ivey, and tasked with developing a strategic plan “that establishes recommendations for policy, regulatory and legislative actions to address the overdose crisis in Alabama.” The Council and its subcommittees have met several times since then, and have submitted its formal plan to the Governor.

“Families, health care professionals and government officials at every level seek real solutions concerning the impact the opioid crisis has on Alabamians,” said Commissioner Beshear. “The next step in our effort will convene the Implementation Team of the Alabama Opioid Overdose and Addiction Council, as well as quarterly meetings of the full council to implement researched opportunities. We believe the work of the council offers preventive strategies, intervention and treatment options, and a community response that addresses this dire need. Working together, it will require organized sustained engagement of citizens and government with healthcare professionals.”

Dr. Harris said, “Opioid addiction and abuse is a tremendous problem that affects Alabama in many different ways. Our hospitals, schools, churches and prisons are all struggling to deal with the problems caused by addiction and by increasing numbers of opioid deaths. The comprehensive action plan the council has developed includes improvements to the Alabama Prescription Drug Monitoring Program that make it easier for prescribers to identify opioid abuse and to motivate abusers to find help for themselves, their families and communities. We are encouraged that the council has offered strategies that have the potential to reverse this crisis that affects so many Alabamians, and appreciate the input of so many individuals to find effective solutions.”

“After working with the dedicated people who have given so much of their time and concern to this council and its subcommittees, I am heartened that we can make progress to fight the terrible blight of opioid abuse in Alabama,” Attorney General Marshall said. “I want to thank Gov. Ivey for bringing us together in a commitment to search for solutions and work toward implementing them. I have been proud to serve with Commissioner Beshear and Dr. Harris in this vital endeavor, and I am grateful to all the members of this Council and its subcommittees for their outstanding achievement in bringing forth these valuable recommendations.”

The Council’s report presents a four-pronged action plan to address prevention of opioid misuse, intervention within the law enforcement and justice systems, treatment of those with opioid use disorders, and community response that engages the people of Alabama in finding solutions at a local level.

Some of the major findings are summarized below:

PREVENTION

Improve and modernize the Alabama Prescription Drug Monitoring Program so that it will be more user-friendly, and more prescribers will participate and be better informed; the Governor is requested to support a legislative appropriation of $1.1 million to the Alabama Department of Public Health for this;
Strengthen prescription data and research capabilities and create a unique identifier for each individual patient;
Promote efforts to educate current and future prescribers, better implement current guidelines, adopt guidelines specific to opioid prescribing and impose mandatory opioid prescribing education;
Create a website and messaging campaign to reduce the stigma of opioid addiction; and implement an outreach program to teach young people the dangers and to avoid opioids;
Create a website and social media campaign to motivate opioid abusers to seek help and to effectively connect them and family members with ways to get help; and
Create a partnership for the Alabama Department of Mental Health to provide training about addiction to law enforcement agencies and the judiciary.

INTERVENTION

Advocate legislation in the 2018 session to specifically prohibit trafficking in fentanyl and carfentanil, which is particularly important because vastly smaller amounts of these than other opioids can be deadly; for example, a lethal dose of fentanyl is 1,000 times less than that of heroin, and the threshold amounts for the crimes of trafficking in fentanyl and carfentanil would better be measured in micrograms; and
As overdoses are 50 times greater for those leaving incarceration or other enforced abstinence, establish a process for the Department of Mental Health to reduce the stigma of medication-assisted treatment, and begin a pilot program by the Department of Corrections in partnership with the Board of Pardons and Paroles to use naloxone, counseling and life skills to help released inmates remain drug free.

TREATMENT AND RECOVERY

Promote adequate funding for treatment services and recovery support;
Establish collaboration between the Department of Mental Health and recovery support providers to increase access;
Support creating two addiction medicine fellowships to train Alabama physicians to recognize and treat substance abuse;
Expand access and target effective treatment and prevention programs to areas where there is greater need; and
Improve education of professionals through continuing education for licensing and expand postsecondary and graduate curriculums.

COMMUNITY RESPONSE

Increase access to naloxone, and maintain a list of participating pharmacies;
Prioritize naloxone to law enforcement and for distribution in areas of greatest need;
Provide naloxone training for first-responders;
Encourage prescribing naloxone for high-risk patients;
Have a Community Anti-Drug Coalitions of America program in each judicial circuit and work toward having them at municipal levels;
Engage employers, businesses, higher education and private-sector in a network to get resources into communities;
Encourage having a Stepping Up Initiative in each county to work with the criminal justice system regarding incarceration of those with mental health problems; and
Develop ways to provide service to veterans regarding opioid issues.

A copy of the Council’s report is available for download here.

Tags: carfentanil, council, fentanyl, force, health, heroin, mental, naloxone, opioid, task

Posted in: Opioid