Report: States missing the mark on protecting public from opioid overdose

Most states are falling considerably short in protecting their residents from potentially deadly prescription opioid overdoses, especially in the area of broadening access to opioid use disorder treatment, states a National Safety Council (NSC) report released last week. Only four states (Kentucky, New Mexico, Tennessee and Vermont) meet five of the NSC's six key indicators of progress in combating the opioid crisis, according to the report.

On the other end of the spectrum, three states (Michigan, Missouri and Nebraska) meet none of the council's six indicators, states the report, Prescription Nation 2016.

“Multiple actions will be needed to end this drug epidemic and reduce the loss of life,” the report states. The report follows an NSC analysis that found that an increase in preventable deaths to an all-time high is largely attributable to opioid overdose.

For the latest report, the NSC examined states' progress on these indicators:

• Requiring that prescribers of controlled substances receive continuing medical education (CME) on pain management, with 17 states meeting this standard. The report states that after New Mexico instituted a requirement for a five-hour CME class on pain and addiction, both high-volume and high-dose prescribing of opioids declined.

• Adopting a guideline for opioid prescribing, with 22 states having done so. The report cites Washington's 2007 introduction of voluntary guidelines (followed by a later mandate targeting licensing boards) that led to greater prescriber awareness and fewer overdose deaths.

• Eliminating “pill mill” operations by enacting laws to regulate pain management services; 12 states met this standard. The report discusses Florida's multifaceted approach that helped transition the state from being labeled the pill mill capital of the nation to more recently having none of the country's top 100 opioid-dispensing physicians.

• Allowing prescribers to appoint a delegate to access data from a state's prescription drug monitoring program (PDMP), a move that has been adopted by 40 states and is seen as an important strategy for integrating monitoring into clinical workflow.

• Allowing the opioid overdose reversal drug naloxone to be prescribed with a standing order, with 35 states meeting this standard. The NSC report recommends that states ensure access to naloxone in all public and private insurance plans.

• Ensuring the availability of opioid use disorder treatment, especially medication-assisted treatment with methadone or buprenorphine. The report points out that rates of opioid abuse or dependence far outpace both maximum buprenorphine treatment capacity and the number of people currently receiving methadone treatment.

Most states have met between one and four of the six indicators, according to the NSC. Six states and the District of Columbia have met one indicator, 18 have met two, 10 have met three and 9 have met four.

Magnitude of crisis

The introductory sections of the report describe the opioid epidemic as “the deadliest drug crisis on record,” adding that much of the public still underestimates its magnitude. The report cites a 2015 NSC opinion poll in which nearly 90% of opioid users said they were not worried about addiction, even though 60% said they had an addiction risk factor such as a family history of alcoholism or a personal history of physical, mental or sexual abuse.

The report concludes with 11 recommendations tied to the six indicators of progress. The final four recommendations center on medication-assisted treatment, and include increasing patient caseload caps for physicians authorized to prescribe buprenorphine, as well as allowing advanced-practice nurses to receive buprenorphine prescribing authority.

The report assesses the issue of supply of methadone and buprenorphine treatment by stating, “With most state [opioid treatment programs] operating at capacity, buprenorphine, which can be prescribed in office-based settings, offers the most viable way to expand access for MAT.”