Opioid Legislation Update: Fourth Circuit
June 12th, 2017 by CHHS RAs
By CHHS RA Bach Nguyen
Note: This is the first in a series of posts covering recent state legislative efforts to address the nationwide opioid epidemic. The posts will be organized by federal judicial circuit, beginning with our home Fourth Circuit, and then proceeding numerically from the First Circuit.
Maryland Governor Larry Hogan signed several bills into law on March 25th of this year. Included in the package are the Prescriber Limits Act of 2017 (HB 1432), which “requires health care providers to prescribe the lowest effective dose of an opioid;” the Distribution of Opioids Resulting in Death Act (SB 539), which “allows prosecutors to seek an additional 10 years for drug dealers who knowingly sell fentanyl and its analogs, including carfentanil, which recently caused at least four overdose deaths in the state;” the Heroin and Opioid Prevention Effort (HOPE) and Treatment Act of 2017 (HB 1329/SB 967), “a bipartisan omnibus bill that contains provisions to improve patient education, increase treatment services, and includes the administration’s Overdose Prevention Act, which enables all citizens to access life-saving naloxone;” and the Start Talking Maryland Act (HB 1082/SB 1060), which will “increase school and community-based education and awareness efforts to continue to bring attention to the crisis and to equip our state’s youth with knowledge about the deadly consequences of opioids.”
Additionally, the Governor also signed a measure to assist in providing treatment to minors, as well as several health insurance measures. SB 443 will allow a parent or guardian to apply on behalf of a minor for admission of the minor into “a certified intensive outpatient alcohol and drug abuse program.” Among the health insurance laws are HB 887, which covers prior authorization for drug products to treat an opioid use disorder. This act is an emergency measure to prevent certain insurers, non-profit health service plans, and HMOs from requiring pre-authorization for certain drug products (namely methadone, buprenorphine, and naltrexone) used to treat opioid use disorders in certain circumstances. Another law is HB 983, which requires counseling for substance abuse disorders for Telehealth services, and generally relates to health insurance coverage and reimbursement for Telehealth services. Lastly, HB 1127 alters some coverage requirements for diagnosis and treatment of mental illness and emotional, drug use, and alcohol use disorders.
Other states in the fourth circuit are also working on legislation to address opioid issues. North Carolina recently received a $31 million federal grant to aid in opioid prevention, treatment, and recovery efforts. One such effort is the Strengthen Opioid Misuse Prevention (“STOP”) Act, HB 243, that passed the House on April 10th, and is awaiting action in the Senate. The bill is a comprehensive act meant to tackle the issue from many angles. In a trip to a particularly affected county in North Carolina last month, “[Atty. Gen. Stein] emphasized a three-prong attack that looks at education, treatment and enforcement… He made a pitch for a piece of legislation known as the STOP Act that would address some issues, including making some derivatives of fentanyl illegal…The legislation would also tighten the prescribing of opioid painkillers.”
South Carolina has also taken steps to address the opioid epidemic in the state. Governor McMaster signed a bill earlier this month that would track patient prescription history before new prescriptions can be written. This is part of a broader plan, including successfully passed legislation that would allow pharmacies to take back prescription pain pills. Additionally, members of the House have created a special committee to study opioid issues, and are calling for increased allocation of funds to spend on drug addiction treatment.
West Virginia has the highest overdose rate in the country, and has taken a few different approaches. “West Virginia’s fight against opioid abuse includes recent legislative approval for a new state Office of Drug Control Policy to coordinate statewide funding, reporting and data about drug use, overdoses, addiction treatment, needs and statewide policy. Another new law authorizes spending $24 million from recent court settlements with opioid distributors to increase inpatient treatment beds, authorizing health officials to ensure they are available in the highest priority areas.” West Virginia also settled a four-year lawsuit against two of the largest drug distributors earlier this year, for a combined total of $36 million. Several counties in the state have also filed lawsuits against several other distributors for harms caused by prescription painkillers.
In Virginia, lawmakers have seen opioid prescriptions drop in the last month, just as new legislation monitoring prescriptions was set to take effect. Similar to Maryland, Virginia has also announced a state of public health emergency, which, among other things, includes a “standing order that allows all Virginians to obtain the drug Naloxone, which can be used to treat narcotic overdoses in emergency situations.” Governor McAuliffe has also taken steps to combat the epidemic such as establishing a task force and targeting “doctor shopping,” a practice by which patients will change doctors in order to find one that will approve a prescription. According to the governor, “by 2020, a prescription monitoring program will be in place so that doctors can check online if a patient has already been prescribed medication.”
Several districts in the fourth circuit have been particularly affected by the opioid epidemic, and while some states like West Virginia have been fighting the epidemic for several years, all states are escalating efforts to combat this crisis.