State Legislators and the Opioid Epidemic: Not Yet Out of the Woods
O’Neill Institute | Leave a Comment
Regina LaBelle and Shelly Weizman are Director and Associate Director, respectively, of the Addiction and Public Policy Initiative at Georgetown University Law Center. LaBelle served as Chief of Staff in the Office of National Drug Control Policy in the Obama Administration. Weizman was Assistant Secretary for Mental Hygiene in Governor Andrew Cuomo’s Administration. Leigh Bianchi, a Georgetown University undergraduate student provided research assistance for this piece.
The opioid epidemic is far from over and as a result, state legislators continue to focus on strategies to curb overdose deaths.
This year, state legislators passed laws expanding access to treatment medications for opioid use disorder (OUD), considered the gold standard of care for this condition. In some states, legislators targeted their efforts to populations most at risk, including people who are incarcerated.
As the National Academy of Sciences declared, failing to provide people with FDA approved medications for OUD is a denial of appropriate medical treatment.
Upon leaving incarceration, an individual’s overdose risk skyrockets. Despite this, too few correctional institutions provide OUD treatment medications. In some cases, policymakers and jail administrators fear misuse of opioid treatment medications. While in other cases, using methadone or buprenorphine is considered “swapping one addiction for another.”
A few states, including Connecticut, Ohio and Oklahoma appropriated new funds to establish treatment programs using OUD medications for their incarcerated population. Connecticut appropriated $8 million for the program in its two year budget, while Oklahoma (SB86) funded a $500,000 pilot project. Ohio (HB166) included funding to reimburse counties for OUD medication treatment program costs in county jails.
Colorado and Maryland also passed laws requiring county jails to phase in OUD medication treatment programs. Colorado’s SB19-008 requires prisons to continue providing OUD medications upon transfer from a local jail, if the individual was receiving medication in the jail. This is an issue in many states where local jails provide OUD treatment medications but people withdraw upon entering a correctional setting without an OUD treatment medication program. Colorado law also requires jails that receive funding from state behavioral health services to develop a plan for access to medications by January 1, 2020. Maryland’s HB116 establishes a phased in approach for OUD treatment medication programs in county jails and connections to care upon reentry.
A few states passed legislation requiring the use of only 1 of the 3 FDA approved medications for opioid use disorder. Indiana SB0293 and Missouri HB10 both funded pilots for justice-involved individuals with alcohol and opioid use disorder using naltrexone. In the future, Indiana and Missouri should revisit this legislation and allow all 3 forms of FDA approved OUD treatment medications.
Federal law now allows advanced practice nurses and physician assistants to prescribe buprenorphine. However, scope of practice laws in several states prevent this. Louisiana and Utah revised their laws to expand the number of practitioners who can provide OUD treatment medications. Louisiana (HB240) now allows advanced practice registered nurses and physician assistants to provide medication for OUD. Utah HB398 allows physician assistants, nurse practitioners and registered nurses to dispense methadone under the direction of a pharmacist at a facility providing medication for OUD.
In West Virginia, HB2010 prohibits the termination of parental rights solely because the parent receives OUD treatment medications. As noted in this Health and Human Services brief, parents are sometimes told by judges or child welfare caseworkers to prematurely taper or not use OUD treatment medications if they are involved with the child welfare system. Legislation of this type marks an important first step to dispelling misconceptions about OUD treatment medication.
Preliminary data signals that 2018 will mark the first time in years that drug overdose death rates have decreased. But a single year is not a trend, nor should it signal to policymakers that the nation’s addiction epidemic is over. It’s a positive sign that states took positive steps to expand access to treatment for those most at-risk of overdose death and facing the most serious consequences from addiction. But much more work remains to reduce the harms associated with substance misuse and tackle the underlying factors driving addiction.