Legislation to limit opioid prescriptions under debate

By Josh Kelety

WNPA Olympia News Bureau

OLYMPIA — State legislators, Attorney General Bob Ferguson and Gov. Jay Inslee are rolling out legislation to limit opioid prescriptions and invest in addiction treatment.

On Jan. 12, the House Committee on Healthcare and Wellness heard public testimony on two bills that would limit the quantity of opioid pain medications that doctors and other providers can prescribe patients who are obtaining opioids for the first time. Patients over the age of 21 could receive no more than a seven-day supply while those under 21 could obtain only a three-day dosage. It also would require that prescribers enroll in a state program to gather data and monitor opioid distribution to prevent over-prescribing.

The former bill also would require that providers notify patients obtaining more than a three-day supply of opioids of the risk of addiction.

The bills are supported by family members of those who have suffered from addiction, as well as law enforcement and public health officials. The bills are opposed by some worried about access to their pain medication as well as lobbyists who were concerned about the burden it would put on doctors.

Both bills were requested by Ferguson, who says they are necessary to prevent patients from becoming addicted and keep excess pills out of medicine cabinets and the hands of non-patients, and to make sure that all providers of opioids participate in the state’s Prescription Monitoring Program, which tracks patient prescription histories.

“The overprescribing of opioids has contributed to this problem which has swept across our state,” said Ferguson. “Despite the attention that this issue has received, overprescribing is still happening.”

Only 35 percent of opioid providers in Washington participate in the voluntary monitoring program, according to Chris Baumgartner, drug systems director at the state Department of Health.

Inslee is moving on opioids as well: He’s requested a bill that prioritizes medication-assisted treatment for addiction —such as buprenorphine — and places those services in prisons and needle exchanges. It also would carry a first-in-the-nation Medicaid waiver to allow people in detention to receive addiction treatment.

There is corresponding funding in his supplemental budget: $15 million for medication-assisted treatment and $4 million for addiction prevention efforts.

Specifically, the governor wants to increase the number of people in treatment by 20 percent each year over the next two years.

“Two Washingtonians a day succumb to and lose life as a result of opioid addiction. And that is unacceptable,” Inslee said. “The state needs to step up.”

Starting in the early 2000s, reported deaths from prescription opioids rose dramatically before peaking in 2008, while deaths from heroin skyrocketed starting in 2010, according to state data. Deaths from fentanyl — a prescription opioid pain medication that is significantly more powerful than heroin — have increased since 2015 as well. In 2016 alone, 694 people died from opioid overdoses, and 446 of those deaths were from prescription drugs.

However, the state experienced fewer fatal overdoses over the first half of 2016 than in the first half of 2017, and prescription opioid deaths have fallen since their peak in 2008, data show.

The governor and attorney general have emphasized overprescribing as a major driver of addiction.

According to a report compiled by the Attorney General’s Office, Washington dentists prescribed the most opioids — roughly 13,000 pills for 13-19 year-olds during a six-month period in 2015 — followed by emergency medicine providers. The report also indicated that Washington counties that experienced high prescription rates generally saw overlapping high rates of opioid overdoses.

However, the proposals aren’t without opposition. While the governor’s bill was relatively well received during a Senate public hearing earlier this week, the attorney general’s bills to limit opioid prescriptions and to force providers to participate in the monitoring program garnered significant pushback from the medical community and people with chronic pain.

“Prescriber fear is at an all-time high in our state,” said Cyndi Hoenhous, a member of Washington Patients in Intractable Pain, at a House hearing Jan. 12. “When it comes to opioid policy right now, providers don’t care about patients like me. Those in pain are now a liability.”

Katie Kolan, with the Washington State Medical Association, criticized the monitoring mandate. The health department already has a group discussing how to bring more providers into the monitoring program and general rules for prescribing opioids, she said. “While well-intentioned, this measure is duplicative and disruptive … and would preempt the department’s rule-making authority,” she said.

Another Washington State Medical Association representative and former state senator, Nathan Schlicher, said that poor integration of the monitoring program with electronic health records is burdensome for medical staff. “It’s bureaucracy as its finest,” he said, going on to call the program “poorly designed.”

“If we do mandates like this it does take time away from patients,” he said.

“We’re not ready for a mandate on this,” said Mellani McAleenan, a representative with the Washington State Dental Association.

Absent from the committee hearings on Ferguson’s bills were pharmaceutical interests. However, PhRMA, a national association representing pharmaceutical companies, including Purdue Pharma, supports the legislation and won’t be lobbying against either bill. The city of Everett has an ongoing lawsuit against Purdue Pharma related to painkillers, the black market and the impact on emergency services, and Snohomish County may join the litigation. The state has a separate lawsuit over marketing practices.