KDA Today

KDA Today

For Immediate Release

Date: Feb 18th, 2019
Contact: Dr. Beverly Largent
Phone: 800-292-1855
Email: kda@kyda.org

Opioids: A Review of Kentucky and National Legislation

Kentucky is well-known for opioid use. It currently ranks in the top ten states with opioid related deaths. Deaths due to opioid use are only a part of the problem. Consider the Neonatal Abstinence Syndrome, HIV prevalence due to injection drug use, and hepatitis C (HCV) due to injection drug use. In 2016, there was a rate of 23.6 deaths per 100,000 in Kentucky - nearly double the national rate. One year earlier in 2015, Kentucky providers wrote 97.0 opioid prescriptions per 100 persons as compared to the national average of 70 per 100 persons. Kentucky ranks third in the US in Neonatal Abstinence Syndrome. The incidence of new cases of HIV and HCV in Kentucky related to injection drug use is one of the highest in the nation. (1) What legislation in Kentucky and the nation has been passed to stem the scourge of abuse, and what actions have been taken to correct the ongoing and largely preventable crisis?

Nationally, the latest action taken is the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act, or SUPPORT. Prior to this legislation, signed by President Trump on October 24, 2018, President Obama signed the Comprehensive Addiction and Recovery Act (CARA) and the 21 Century Cures Act. The CARA act expanded the availability of naloxone, improved prescription drug monitoring, and shifted resources towards identifying and treating incarcerated drug addicts. (2) The 21st Century Cures Act was designed to bring help to addicts by accelerating research into innovative new drugs and products for recovery. By and large the government continued to wage a “war on drugs”, with little change in the rate of opioid use after the enactment of these two acts.

The SUPPORT act is not without controversy. The 250-page law signed by President Trump on October 24, 2018, has been especially challenged due to lack of funding. Congress has appropriated $8.5 billion this year for opioid-related programs. SUPPORT, as well as previous legislation, has failed to bring about a coordinated federal strategy, but many of its parts can bring help to states like Kentucky, where the rate of opioid use is high. Senate Majority Leader, Mitch McConnell describes the law as a landmark bill with four aims: “to reduce the abuse of opioids, to encourage recovery, to provide support to caregivers and families, and to drive innovation and long-term solutions.” (4) The law is intended to increase access to evidence-based treatment, especially for pregnant women and people in rural areas. (3)

The SUPPORT act increases the numbers of providers who can prescribe the opioid-agonist methadone or buprenorphine, the standard for treating opioid use disorder. Roughly, only 20% of Americans with the disorder report being able to have access to the dugs for treatment, due to the strict regulations governing who can prescribe the drug. Included in the law is the use of telemedicine to prescribe the opioid – agonist therapy, a boon for those in rural areas.

To care for children and pregnant women, the SUPPORT act requires state CHIP programs to provide mental health and substance abuse disorder benefits on par with benefits for physical health. It also allows Medicaid funds to be used to pay for services for babies with Neonatal Abstinence Syndrome, including counseling for mothers and caregivers. The SUPPORT act permits young adults who were formerly in foster care to receive Medicaid coverage until age 26. Older adults are funded through Medicare to have substance abuse screening and treatment. (3)

Senator Mitch McConnell authored two provisions of the senate bill that became law, the CAREER act and “Protecting Moms and Infants Act.” The CAREER act encourages local business and treatment groups to form partnerships helping those in recovery find and maintain employment and provides provisional housing options for those in recovery. The “Protecting Moms and Infants Act” is directed to infants born into addiction by increasing grant resources for organizations battling this problem. (4)

Besides increasing funding streams through grants, the federal legislation also has provisions to restrict smuggling of opioids such as fentanyl. Part of the law give federal agencies like the U.S. Postal Service funding for security improvements to stop illegal drug shipments.

Kentucky has had two initiatives to stem opioid use. The first was house Bill 1, passed in 2012, which expanded the Kentucky All Schedule Prescription Electronic Reporting System. This is commonly referred to as KASPER. This bill requires all “providers of controlled substances to register. It requires pain management clinics to be owned by a licensed medical practitioner and requires professional licensure boards to investigate prescribing complaints immediately. The legislation allows for better coordination between health regulators and law enforcement to address problems of abuse. Finally, elements of HB1 have helped prevent Kentucky from becoming a source state for prescription pills.” (5)

House Bill 333 was signed into law February 26, 2015. It is best known for the section in the law which limits the amount of a Schedule 2 controlled substance prescriptions to a length of three days. Most of the law is aimed at controlling fentanyl. “This bill defines fentanyl derivatives in such a way that any derivative that appears in Kentucky that is not FDA-approved will be a Schedule 1 controlled substance. It allows the use of a Cannabidiol product when and if the FDA approves it. HB 333 expands the charge of importing heroin to include fentanyl and its derivatives and increases penalties on trafficking in fentanyl and its derivatives to a C felony, regardless of the amount. This legislation adds fentanyl and its derivatives to the aggravated trafficking statute, a class B felony if the amount of fentanyl trafficked is more than 28 grams. If the substitute is carfentanil (also carfentanyl) or a derivative, the aggravator is 10 grams or more. And finally, this bill creates the charge of trafficking in a misrepresented controlled substance when an individual knowingly traffics in fentanyl or fentanyl derivatives made to resemble a legitimate pharmaceutical product.” (5)

Most recently, on March 15, 2018, Senator Alice Forgy Kerr marshalled into law Senate Bill 6 which requires opioids and other abused drugs to be disposed of using an environmentally-conscious disposal solution. DisposeRX is the recommended drug disposal system, which provides solidifying materials that when mixed with water in the drug vial renders the drugs unusable. Walmart announced on January 17 that the 105 pharmacies in Kentucky will give a DisposeRX packet with every opioid prescription. The National Institute of Drug Abuse estimates that approximately 70% of addictions, overdoses and deaths are related to the abuse of painkillers that remain in medicine cabinets.

In February 2017, Kentucky received $10,528,093 through the 21st Century Cures Act. This grant money is being used through the Kentucky Opioid Response Effort or KORE. The Kentucky Department for Behavioral Health, Development and Intellectual Disabilities within the CHFS is the applicant agency. “KORE includes funding for over 30 different initiatives including; school-based interventions aimed at decreasing future risk for SUD and promoting better prescribing around opioids. Treatment priorities include programs to increase the likelihood that individuals who present to an emergency department after an overdose enter treatment. KORE also includes funding to provide services to those re-entering the community after incarceration, services for women who are pregnant and/or parenting, and harm reduction, which is critical in decreasing the likelihood of overdose death and the spread of infections such as Hepatitis C and HIV.” (6)

The SUPPORT act reauthorizes funding from the Cures Act, and simultaneously gives states more flexibility in using the funding. State leaders are optimistic that the SUPPORT act will allow Kentucky more funds, especially in the much-needed area of transition from treatment to gainful employment.

References
1. National Institute on Drug Abuse, Kentucky Opioid Summary; https://www.drugabuse.gov/drugs-abuse/opioids/opioid-summaries-by-state/kentucky-opioid-summary ; accessed 1-21-19.
2. S. 524 – 114th Congress: Comprehensive Addiction and Recovery Act of 2016; 2. www.GovTrack.us.2015.January 21,2019; https://www.govtrack.us/congress/bills/114/s524
3. Perspective: The SUPPORT for Patients and Communities Act –What Will It Mean for the Opioid-Overdose Crisis?, Carey S. Davis, J.D., M.S.P.H.; New England Journal of Medicine; January 21, 2019; https://www.nejm.org/doi/full/10.1056/NEJMp1813961
4. Landmark opioids bill can save lives, get Kentucky back to work, Kentucky Today, by Mitch McConnell; http://kentuckytoday.com/stories/landmark-opioids-bill-can-save-lives-get-kentucky-back-to-work-today; accessed January 21, 2019.
5. Legislative Initiatives; https://odcp.ky.gov/Pages/Legislative-Initiatives.aspx; accessed January 14, 2019.
6. Kentucky’s Opioid Response Effort, Medical News. https://www.medicalnews.md/kentuckys-opioid-response-effort/ ;
accessed 1-7-2019.

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