Senate HELP Committee hears potential solutions to opioid abuse
Challenges of Pain
Senators present during a U.S. Senate Committee on Health, Education, Labor, & Pensions (HELP) hearing on opioid abuse in America each rattled off staggering statistics about opioid drug overdose deaths in their respective states.
“I’m not alone in hearing about these challenges,” said Sen. Lamar Alexander (R-TN), Chairman of the HELP Committee. “It affects all of our states.”
The senators’ high attendance rate at the December 8 hearing indicates that opioid abuse has become a high-priority issue across the country. Opioid abuse is being called a public health crisis, with deaths from opioid drug overdoses tripling over the last 15 years and the number of heroin users doubling since 2005, according to CDC.
Senators heard from Baltimore City Health Commissioner Leana Wen, MD, and Robert Valuck, PhD, BSPharm, a professor in the department of clinical pharmacy at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences. Their witness testimonies discussed initiatives that have been working in Baltimore and Colorado. The third witness, Eric Spofford, who is in recovery from addiction, shared his personal story, which started with oxycodone addiction as a teenager.
Urging Congress to do more
All panelists urged Congress to do more not only to prevent more Americans from becoming addicted, but also to bolster the tools in place that can save more lives, including expanding the availability of naloxone and improving access and coverage for inpatient treatment.
Valuck said Colorado has increased access to naloxone through a standing order. By January 2016, more than 400 pharmacies, including chains and community pharmacies, will have naloxone available.
Spofford said that he overdosed five times and that naloxone was used to save his life. He’s been sober 9 years and has opened two treatment centers in New Hampshire, which take an abstinence approach to treatment.
Although the importance of naloxone was not disputed, witnesses expressed concern that the soaring cost of naloxone may prevent its benefits from being realized, even though demand for it has increased. Wen highlighted that price increases have hindered their efforts in Baltimore. “We have to pick and choose who will get this,” said Wen.
Support for pharmacists
In a letter to the HELP committee, APhA expressed support for pharmacists to be able to furnish opioid reversal agents and for insurance policies to cover naloxone prescriptions from all providers, including pharmacists, for patients and caregivers who may need it.
APhA also said in the letter that giving sites and providers more access to naloxone requires corresponding training related to appropriate use and administration of the drug.
During the hearing, there was also broad support for interoperable prescription drug monitoring programs (PDMPs) and educating youth on prescription drug addiction. Many senators were eager to hear suggestions about how to prevent more Americans from becoming addicted in the first place.
Senators and witnesses both were split on the effectiveness of and need to access medication-assisted treatment (MAT).
Instead of abstinence, MAT is growing in acceptance, with methadone, buprenorphine, and naltrexone used in combination with counseling to treat opioid use disorder.
The U.S. Department of Health & Human Services (HHS) supports MAT and announced this fall that HHS would make it more widely available.
Loren Bonner, MA,
New regulation in Florida on controlled substances
The Florida Board of Pharmacy has adopted a rule revision—on standards of practice for the filling of controlled substance prescriptions, electronic prescribing, and 2 hours of mandatory continuing education—that went into effect December 24, 2015.
The rule revision was prompted by the state board’s view—based on testimony from the general public—that perhaps the 2002 rule “was guiding pharmacists towards making a presumption that the prescription is not good,” according to Florida Pharmacy Association Executive Vice President and CEO Michael Jackson, BSPharm, CPh, who served on the board’s controlled substance standards committee. “The board’s philosophy now is: let’s make a presumption that the prescription was issued for a specific purpose and is valid. And let’s write a rule in such a way to help the pharmacist confirm validity of the prescription rather than to look at a prescription and find reasons not to fill it.”
The rule revision begins with a clear statement: “The Board of Pharmacy recognizes that it is important for the patients of the State of Florida to be able to fill valid prescriptions for controlled substances. In filling these prescriptions, the Board does not expect pharmacists to take any specific action beyond exercising sound professional judgment. Pharmacists should not fear disciplinary action from the Board or other regulatory or enforcement agencies for dispensing controlled substances for a legitimate medical purpose in the usual course of professional practice. Every patient’s situation is unique, and prescriptions for controlled substances shall be reviewed with each patient’s unique situation in mind. Pharmacists shall attempt to work with the patient and the prescriber to assist in determining the validity of the prescription.”
Visit www.flrules.org and search on “64B16-27.831” to learn more about the new Florida regulation.
Diana Yap, Editorial Director