Bills would limit opioid prescriptions, invest in treatment options

But some pain sufferers are worried about losing access to medication they need

OLYMPIA — A bill introduced in the state Legislature would limit the quantity of opioid pain medications that doctors and other providers could prescribe patients who are obtaining opioids for the first time.

Patients older than 21 would be able to receive no more than a seven-day supply; those younger than 21 would be able to obtain only a three-day dosage, and providers would be required to notify patients of the risk of addiction.

Another bill would require prescribers of opioids to enroll in a state program to prevent over-prescribing.

While supported by family members of those who have suffered from opioid addiction, and law enforcement and public health officials, the bills are opposed by pain sufferers who are worried about losing access to medication they need, as well as lobbyists for the medical community who are concerned about the burden it would put on doctors.

Both bills were requested by state Attorney General Bob Ferguson, who argues that the limitations are necessary to prevent patients from getting addicted and keep excess pills out of the hands of non-patients; and to make sure that all providers of opioids participate in the state’s Prescription Monitoring Program, which tracks patient prescription histories.

“The overprescribing of opioids has contributed to this problem which has swept across our state,” Ferguson said. “Despite the attention that this issue has received, over-prescribing is still happening.”

Only 35 percent of opioid providers in Washington currently participate in the voluntary Prescription Monitoring Program, according to Chris Baumgartner, drug systems director at the state Department of Health.

Gov. Jay Inslee is taking action against opioids as well: He’s requested a bill that prioritizes medication-assisted treatment—such as buprenorphine—for people suffering from opioid-use disorder, places medication treatment services at contact points such as prisons and syringe exchanges, and creates a first-in-the-nation Medicaid waiver to allow incarcerated individuals suffering from addiction to receive treatment.

His supplemental budget also calls for investing roughly $15 million in medication-assisted treatment—including setting up drug treatment services at contact points such as jails. Additionally, Inslee wants another $4 million to increase the number of individuals in treatment by 20 percent each year over the next two years, a benchmark he called an “aggressive goal.”

“Two Washingtonians a day succumb to and lose life as a result of opioid addiction. And that is unacceptable,” Inslee said. “The state needs to step up.”

Starting in the early 2000s, reported deaths from prescription opioids rose dramatically before peaking in 2008, while deaths from heroin skyrocketed starting in 2010, according to state Department of Health data. Deaths from Fentanyl — a prescription opioid pain medication that is significantly more powerful than heroin — have increased since 2015 as well. In 2016 alone, 694 people died from opioid overdoses, 446 of which were from prescription drugs.

However, the state experienced fewer fatal overdoses over the first half of 2016 than in the first half of 2017, and prescription opioid deaths have fallen since their peak in 2008, according to Baumgartner.

The governor and attorney general say over-prescribing of opiates by providers is a major driver of opioid addiction in the state.

According to a report compiled by the Attorney General’s Office, Washington dentists prescribed the most opioids —roughly 13,000 pills for 13- to 19-year-olds during a six-month period in 2015 — followed by emergency medicine providers. The report indicated that Washington counties that experienced high prescription rates generally saw overlapping high rates of opioid overdoses in recent years.

However, the proposals aren’t without opposition. While the governor’s bill was relatively well received during a Senate public hearing earlier this week, the attorney general’s bills to limit opioid prescriptions and require participation in the state’s monitoring program garnered significant pushback.

“Prescriber fear is at an all-time high in our state,” said Cyndi Hoenhous, a member of Washington Patients in Intractable Pain, at a House hearing on Jan. 12. “When it comes to opioid policy right now, providers don’t care about patients like me. Those in pain are now a liability.”

Katie Kolan of the Washington State Medical Association criticized the prescription monitoring mandate as redundant. The Health Department stakeholder group is already discussing rules for prescribing opioids and how to bring more providers into the monitoring program, she said. “While well-intentioned, this measure is duplicative and disruptive to efforts done by the state currently to implement the rule making and would preempt the department’s rule-making authority,” she said.

Nathan Schlicher, a Washington State Medical Association representative and former state senator, said poor integration of the monitoring program with the electronic health records system is burdensome for medical staff. “It’s bureaucracy as its finest,” he said, calling the program “poorly designed” and “poorly integrated.”

“If we do mandates like this, it does take time away from patients,” Schlicher added.

Mellani McAleenan of the Washington State Dental Association said dentists “[are] not ready for a mandate on this.”

Notably absent from the committee hearings were pharmaceutical interests. However, PhRMA, a national association representing pharmaceutical companies, including Purdue Pharma — the company that aggressively marketed Oxycontin to the medical community and downplayed its addictive qualities in the 1990s and early 2000s, according to reporting by The New Yorker — supports the legislation and won’t be lobbying against either bill.

“We recently announced our support for policies that limit the supply of opioids to no more than seven days for patients with acute pain, a significant step for our industry,” a PHrMA spokesperson said. “We also support strengthening and improving the state-run electronic databases that track prescribing of controlled substances.”

Attorney General Ferguson is currently suing Purdue Pharma for deceptive marketing practices.

People testifying in support of the attorney general’s bills had passionate responses to the concerns of patients in chronic pain and the medical community.

“It’s ridiculous. Honestly, this is the worst man-made epidemic in modern medical history and we’re talking about how much time it takes,” said Gary Franklin, the Department of Labor and Industries Medical Director. “These drugs are potentially deadly.”

Brenda Zane, whose 19-year-old son recently survived an overdose on Fentanyl, said “I know that these bills aren’t going to end this crisis, but they can stem the flow of diversion if medicine cabinets aren’t full of leftover pills. I’ve heard a lot about inconvenience and burdens … How about $150,000 in medical costs? Those are burdens that I’m carrying. And my son lived. So we’re the lucky ones.”

— Josh Kelety is a reporter for the WNPA Olympia News Bureau