The Arizona legislature unanimously approved the Arizona Opioid Epidemic Act, which Gov. Doug Ducey signed into law on Jan. 26. The plan to curb opioid overdoses includes funding to expand access to addiction treatment, and tighter regulation around dosages and initial prescriptions.
“This legislation combats the opioid epidemic from all angles,” said Ducey, in a release. “It holds bad actors accountable, and gets more resources to our medical professionals, law enforcement, and treatment providers, while showing compassion to those struggling with addiction and protecting those suffering from chronic pain.”
Arizona has 70.2 opioid prescriptions for every 100 people—higher than the national average of 66.5 prescriptions per 100 people, according to the Centers for Disease Control and Prevention. One Arizona county, Mohave, even had more prescriptions than people, with 127.5 prescriptions for every 100 people, according to an analysis of federal data by The Arizona Republic.
In the past six months alone, 5,512 possible opioid overdoses were reported, according to the Arizona Department of Health Services.
The new state law includes $10 million for the uninsured and underinsured in need of addiction treatment. Dennis Regnier, the director and CEO of CODAC Health, Recovery and Wellness, one of Tucson’s largest providers of opioid addiction treatment, said it’s a good start.
Regnier said there is nothing more frustrating than when someone’s ready to come into treatment and there’s a financial barrier.
“Anything financial that we can do to increase access to care is important,” he said.
New regulations also limit new opioid prescriptions to an initial five-day maximum. Research shows that opioid dependence sharply increases on the sixth day of consecutive use. Categories of people with extreme pain are exempt from this regulation, including patients with cancer, severe burns, traumatic injuries, in hospice, in nursing homes and receiving end-of-life care.
The law also boosts pain-clinic regulation, and limits the maximum dose most chronic-pain patients can receive. One concern with tighter regulation is that people with chronic pain will have a harder time accessing the medication they need.
Dan Barden, vice-president for clinical services at CODAC, doesn’t think this will be an issue. He said the restriction of the initial five-day prescription doesn’t stop people from getting more pain medication prescribed if they need it. Barden added that the resitriction doesn’t apply to people with chronic pain already working with a physician.
“People who genuinely need medication for pain are going to have those medications available to them,” he said.
The law also requires that narcotic prescriptions go entirely electronic by early to mid-2019. This measure is intended to stop paper prescriptions being altered, duplicated or stolen. Between 3 to 9 percent of opioid abusers use forged prescriptions, according to the Arizona Opioid Epidemic Act.
Smaller counties are being allowed more time to switch to the electronic system. But some rural-area doctors may not have the technological capability or finances to undertake the shift, said Republican state lawmaker Todd Clodfelter.
He also said another new regulation, the “good Samaritan law,” which sunsets in five years, was one that had a number of his colleagues raising an eyebrow. It allows people to report someone’s overdose without being prosecuted for their own drug use. States that enacted similar laws saw a decrease in opioid deaths. Clodfelter is concerned this is essentially giving people amnesty for their crimes.
He also thinks the law was passed too quickly and wishes lawmakers would have had more time to review it.
It may have seemed quick to lawmakers, but Regnier was on a government taskforce for substance abuse for over eight months, along with 35 other health professionals across the state who gave the governor’s office 104 recommendations on how to mitigate the crisis.
“There’s been building blocks to this legislation,” he said, adding that a lot of the new measures came directly from the taskforce’s recommendations.
The safe-guard drug
In June, the Arizona Department of Health Services released data showing opioid overdoses had increased 74 percent from 2012 to 2016, and continued on an upward trend. In response, Ducey declared a statewide emergency, which included instructing the ADHS to investigate ways of mitigating overdoses and deaths. One of the measures the ADHS looked at was reversing overdoses by using Naloxone, a drug that reverses the effects of an opioid overdose.
There were about 2.1 million opioid prescriptions in Arizona in the last six months, or an average 80,000 every week, according to Symphony Health Solutions, a data-collector for healthcare providers. There were only an about 7,000 total prescriptions of Naloxone in that time, with a marked increase last October.
Since Ducey’s declaration, ADHS trained more than 1,200 first responders to carry and administer Naloxone, and provided more than 5,100 Naloxone kits to law enforcement agencies.
Most insurance covers Naloxone with a common copay of $20 or less. And it can be bought over the counter.
Opioids are used to mitigate pain for everything from having wisdom teeth removed or spraining an ankle to end-of-life care. If you’re taking a chronic-pain opioid medication, you should probably have a prescription for the antidote, said Thom Duddy, executive director for Adapt Pharma, a Narcan developer, one of Naloxone’s brand names.
In conjunction with the state’s new regulations, Duddy said doctors are encouraged to have “better discussions about pain management for new opioid patients.” Doctors are also recommended to prescribe Naloxone to patients in one of three risk categories: People with a history of addiction, those prescribed a higher dosage and those who take a prescription sleeping aid.
“The state’s goal is to curb opioid prescriptions to when it’s necessary and make sure the antidote is readily available to reduce death,” Duddy said.