House passes ‘comprehensive’ opioid bill

After a floor debate laced with stories of the toll drug addiction has taken across Connecticut, the House on Monday unanimously passed what legislators described as a comprehensive measure aimed at curbing the epidemic of opioid and heroin abuse.

The proposal, approved 144-0, would require first responders to carry overdose-reversing drugs, limit initial opioid prescriptions to seven-day supplies in most cases involving acute pain, make changes to a prescription monitoring program aimed at helping prescribers identify patients who could be misusing drugs, and charge the state’s Alcohol and Drug Policy Council with developing a plan to reduce the number of opioid-induced deaths in the state.

Drug overdoses now kill an average of two people in Connecticut each day – more than car accidents. Last year, 723 people died from accidental drug overdoses in the state, and more than 60 percent involved opioids.

“They’re digging graves in every town in Connecticut,” Public Health Committee Co-Chair Rep. Matt Ritter, D-Hartford, said. He noted that more than 50 bills on the topic were submitted to the committee at the start of the session – a sign of the level of concern among lawmakers across the state.

The proposal, which incorporates elements of multiple bills considered during the legislative session, now goes to the Senate. Ritter described it as the most comprehensive piece of legislation dealing with opioid prescribing in the country.

During discussion on the bill, legislators spoke of the toll of drug use in their communities. Rep. Fred Wilms, R-Norwalk, recalled a recent conversation with a local restaurant owner, who said they were having problems with staffing, because so many of their workers were addicted to heroin.

Rep. Tom O’Dea, R-New Canaan, described stories of high school students finding out when their classmates get their wisdom teeth out, because it means there will probably be leftover opioids available. Many of those who misuse opioids get them from friends or relatives.

Rep. Sean Scanlon, D-Guilford, told the story of Nick Kruczek, who got an oxycodone pill from a hockey teammate before his first high school game, when he was 14, and died of an overdose 11 days before his 21^st birthday. Earlier this year, his mother, Sue, spoke at a press conference on the seven-day prescribing limit. Sue Kruczek said her son never got a prescription for opioids but developed an addiction from using other people’s leftover pills.

“This epidemic has impacted our cities, our towns, both urban as well as rural areas,” said Rep. Prasad Srinivasan, R-Glastonbury, the top House Republican on the Public Health Committee and the only physician in the General Assembly. “It has not spared any socioeconomic group.”

“The death rate in our nation is staggering, and it affects very single community,” said Rep. Roberta Willis, D-Salisbury. “Many view this as an epidemic, and I agree.”

Gov. Dannel P. Malloy, who proposed parts of the bill, pledged to sign it. “Addiction is a disease – we should treat it as just that,” he wrote in a joint statement with Lt. Gov. Nancy Wyman. “That this bill would limit opioid prescriptions for no longer than seven days is an important, proactive step to curb this alarming trend, which is impacting communities throughout our state and throughout our nation.”

What the bill would do

The proposal would limit initial opioid prescriptions for acute medical conditions to a seven-day supply. While an adult could receive a subsequent prescription for a longer duration, prescriptions for minors would remain limited to seven days under the proposal.

But medical practitioners could exceed the seven-day limit if they deem it necessary in cases of acute pain, or to treat chronic pain or pain associated with cancer or palliative care. In those cases, the prescriber would be required to document the patient’s condition in the medical record and indicate that an alternative to the opioid was not appropriate. Ritter said the idea was to require a prescriber to “take a step back” and document why it was necessary to go beyond the usual limit.

Ritter and Srinivasan said they have heard concerns from people who use opioids to deal with chronic pain, as well as from people worried about the inconvenience and cost of getting multiple refills. Srinivasan said the inconvenience would be minimal compared to the state’s overdose problem. Ritter, meanwhile, acknowledged that some people could end up having to pay multiple copays if they need to refill a prescription after seven days, and said lawmakers must make a policy decision about whether they’re comfortable with the added costs given the reduction it could bring in leftover pills that could be abused. And for long-term treatment, he added, the prescription length would probably be higher than seven days.

The bill also requires a working group to study whether to set the limit to three days for minors, something some Republican legislators have sought. Ritter said legislators settled on seven days as a reasonable limit after lots of consultation with professionals, and said there were concerns that a shorter limit could cause someone to run out of medication on a weekend and be unable to get a refill.

In addition, the proposal would require municipalities to ensure that emergency responders are equipped with and trained in the use of an opioid antagonist – a drug that can reverse the effects of an opioid overdose. The bill calls for the first responders carrying the medication to be those who are likely to be the first to arrive at the scene of a medical emergency. Ritter said first responders in most large cities and towns already carry opioid antagonists such as naloxone.

In Waterbury, first responders who carry naloxone have used it to reverse overdoses almost once a day, Rep. Theresa Conroy-D-Seymour, said.

Other provisions of the bill would make the following changes:

• Insurance plans would be required to cover naloxone or other medications that treat overdoses without requiring prior authorization. None currently impose such requirements, according to testimony from both insurers and state officials.
• A prescriber, or someone acting on his or her behalf, would be required to review a patient’s records in the state’s electronic prescription drug monitoring program before prescribing a controlled substance to the patient with more than a 72-hour supply. In cases of prescriptions for prolonged treatment, practitioners or those acting on their behalf would have to review the patient’s records in the program regularly.
• Membership would be expanded on the Connecticut Alcohol and Drug Policy Council, which is currently composed of state agency officials and others involved in substance abuse treatment and recovery. The council has been charged with developing a plan for programs, services and criminal sanctions that address substance abuse. The bill would also require them to, by Jan. 1, develop measurable goals that include reducing the number of opioid-induced deaths in Connecticut.