The alarming abuse of prescription painkillers known as opioids, an epidemic that has caused drug overdose deaths to soar nationwide, has sent policymakers and politicians scrambling for solutions — sometimes raising the hackles of medical professionals, who are rightly wary of politicians telling them how to do their jobs.
Hawaii is no exception. Lawmakers made significant concessions to medical groups and others in removing some of the stricter provisions of Senate Bill 505, a measure that would more closely regulate opioid prescriptions. The bill was sent to a final floor vote after clearing a conference committee Thursday.
SB 505 is a rational response to a growing problem, and deserves support. The bill would require informed consent by a patient before receiving opioids, and limits initial prescriptions to seven days, with some exceptions.
The need for tighter controls stems from the growing popularity of prescription opioids as well as their widespread misuse, presumably by ill-informed patients or opportunistic abusers.
Prescription opioids — which include drugs like oxycodone, hydrocodone and methadone, and are sold under such brand names as OxyContin, Percocet and Vicodin — can be highly addictive. They minimize the body’s perception of pain and can trigger feelings of pleasure by boosting dopamine, but also can slow breathing and the heartbeat. Those without access to such drugs may choose a cheaper alternative like heroin — also an opioid.
Nationwide, the number of overdose deaths involving opioids has quadrupled since 1999, according to the Centers for Disease Control and Prevention (CDC). This trend mirrors the amount of prescription opioids sold in the U.S. since 1999, which also quadrupled. The CDC estimates that 91 people die from opioid abuse in the U.S. every day.
In Hawaii, as in other states, the data are just as troubling. Between 2000 and 2014, drug poisonings replaced motor vehicle crashes as the leading mechanism of fatal injuries, according to the state Department of Health. Between 2010 and 2014, prescriptions drugs accounted for more fatal poisonings than illicit ones like heroin or methamphetamine. Opioids account for an increasing number of those deaths.
Under SB 505, if you want to prescribe or receive an opioid, you would have to jump through more than the usual hoops.
Providers would be required to adopt written opioid prescription policies, including obtaining informed consent from the patient. The Department of Health would provide a template of a consent agreement — although details of what should be in that agreement were deleted in the bill’s final version. The template should include some of those missing details, especially providing the patient with information about non-opioid treatment options and how to avoid overdosing.
Initial prescriptions would be limited to seven days, except for specific conditions listed in the bill, such as for chronic pain, palliative and hospice care, and cancer treatment. To extend the prescription beyond seven days, a doctor must follow a specified consultation process with the patient.
Time will tell if such legislation changes the trend. Public and professional knowledge about the dangers of opioid abuse have expanded greatly in recent years. Some self-correction among providers and patients can be expected, and other tools have been introduced.
Last year, the Legislature passed a bill providing immunity for those administering an opioid antagonist like naloxone to reverse the effects of overdosing. Doctors and pharmacists can monitor patient prescriptions through the state’s online Hawaii Prescription Monitoring Program. It’s free, and Hawaii doctors should take advantage of it.
The best deterrent to opioid abuse, however, will remain where it always has been — with a consciencious prescriber and a careful patient.