Policy Proposal Reduce Mortality from Opioids

Goal Statement

My goal in this policy brief is to continue to bring awareness to the opioid epidemic specifically in Ohio and show that the problem is getting worse and not getting better. I would like to include how the medical field has such a large hold on this epidemic and how I feel a different route of medication could help reduce the deaths in Ohio from opioids.

Scope of the Problem

History of the problem

The opioid problem started around 1991 when doctors started distributing and promoting opioid prescriptions for non-cancer pain even though there was a large lack of data concerning the benefits and risks of being on these medications. By 1999, only 14% of the patients on opioid prescriptions were using them for cancer pain. A notable increase in prescriptions for pain has occurred since 1999, while pain reported has not changed much. The problem came to the surface again in 2010 when opioid prescriptions were becoming harder to obtain and people were turning to heroin and a rapid increase in deaths started occurring; heroin deaths raised from 2002 to 2013 by 286%. In 2013 synthetic opioids, like fentanyl, became the most current increase in deaths with over 20,000 in 2016.

Present status of the problem

The problem today has quadrupled since 1999 with 115 deaths every day from the use of opioids, these numbers are growing daily. In 2016, there were 4050 Ohio residents who unintentionally overdosed; making Ohio fourth in the highest overdose death rate count. In 2017, Cuyahoga County had 867 overdose deaths, Hamilton County with 856, Franklin County with 760, and Montgomery with 742 deaths. Post-surgery patients are still being prescribed opioids for painkillers when one out of three patients continue to not use a single opioid and can control their pain with Tylenol, Motrin, or Advil. Even the patients who had used some of the opioid prescriptions, 28% of the patients admitted that they were given far too many. This problem extends out to the court system because there is such an increase in criminal cases but it also extends to foster care due to the parents who can not take care of their children.

Populations affected

The opioid epidemic has touched every demographic, there isn’t one group or area that has not been affected. In Ohio, the big cities are being hit the hardest: Cleveland, Toledo, Columbus, Cincinnati, Akron. College students have been known to take it to ease stress at school or have been introduced to it at parties. Veterans have been prescribed it ease pain and PTSD. Opioids and heroin are in the poorest parts of the cities and most certainly the richest suburban cities as well.

Past Policy

To help eliminate the epidemic, the FDA had eliminated automatic refills and converted the policy to need a new prescription from the provider in the past. They also reinforced a stronger warning label on the medication bottles. The biggest change was when the FDA allowed pharmacists and prescribers to access a patient's medical and prescription records to try to recognize the reoccurring activity. Insurance companies have also increased the regulations to have medications covered, including extensive diagnoses codes and even formal letters from physicians explaining the needed use. On top of these precautions, the FDA has reduced the number of prescriptions available, promoted drug take-back programs, and supported overdose prevention.

In the fall of 2011, Governor John Kasich created the Governor’s Cabinet Opiate Action Team (GCOAT), which has included many of the advancements in the epidemic. GCOAT has included many changes in law enforcement, preventing young use, encouraging appropriate use, treatment, and recovery, and increasing who can save lives. Governor Kasich has passed laws to shut down pill mills, to require children to be educated on prescription medication and opiate abuse, to allow first responders to administer naloxone (Narcan), then to allow family and friends to get prescriptions of naloxone for loved ones, and then further to allow pharmacists to dispense naloxone without a prescription. In 2016, he passed Ohio’s “Good Samaritan” provision which included that any person who helped obtain emergency help for a victim who had overdosed would be waived from law enforcement charges. Law enforcement has become more involved with solving the problem. Between the years 2011 and 2014, law enforcement had confiscated about 170,000 prescription pills and 111,500 grams of heroin. But those numbers increase drastically; in 2016 alone, 64,708 prescription pills and 284 pounds of heroin were confiscated.

Governor John Kasich began the program Start Talking! in January 2014, a program provided by parents, teachers, guardians, and community leaders to educate the youth on drug prevention. In the same year, a federal grant was used in improve the Ohio Automated Rx Reporting System. In 2016 the system showed that there were 86,129 prescriber and pharmacist requests, but more shockingly, in 2017 there were 265,242 requests. Treatments in prisons, jails, and after-care facilities have been issued funds to allow abusers to remain sober and strategies to succeed. Ohio’s Bureau of Workers’ Compensation had even created rules requiring doctors to extensively think about individualized treatment plans, risk assessment, monitoring progression, and the improvement of the patient when prescribing any pills. In 2016, Project DAWN (Deaths Avoided with Naloxone) began offering education to the community on overdose as well as distribution of Naloxone, a medication that has the potential to reverse an overdose which reinstates breathing and obstruct brain damage.

Current Policy

Introduction

Last year, Governor John Kasich passed a bill that does not allow adults to be prescribed more than seven days of opioid prescriptions and five days for minors (exceptions excluded) by dentists or primary care. Gov. Kasich also put into place that doctors who were to not follow these rules would have their licenses revoked (Unknown, 2017.) While Gov. Kasich was scrutinized by many chronic pain patients, he has continued to improve the way doctors will handle prescriptions with patients. This year, he has implemented “safety checkpoints.” The checkpoints will make it mandatory for doctors to reevaluate patients who are taking larger doses of morphine; when patients are prescribed larger amounts, doctors will be required to get a pain management agreement and enforce having naloxone in the patients' possession while on these medications. Project DAWN (Deaths Avoided With Naxolone) has also been put into effect to help the epidemic.

Currently in-place policies

Project Dawn is one of the current policies to help Ohio’s opioid epidemic. Project DAWN offers information on how to help someone on opioids, how to identify signs or symptoms, and most importantly, teaches how to use ganaxolone to potentially save somebody's life. Project DAWN also made disposing of unwanted medications easier. This project not only informs the community of the potential signs and dangers but also offers ganaxolone kits for free; the kits consist of two vials of naloxone medication, two nasal atomizers, a face mask, a DVD to teach how to dispense, and a booklet with more information.

Specific Nature of Current Policies (including any benefits and services associated with the policy)

(Identify the specific nature of current policies, where relevant identifying the eligibility processes and specific services and benefits associated with the current policy.)

Pros and Cons of the current policies

(Do a general pros and cons analysis)

Policy Proposal Supported or Opposed

The policy supported in this proposal is the distribution of medical marijuana for chronic pain patients instead of the prescription of opioids.

Who proposes the new or revised policies that address the identified problem and why? Who opposes these changes?

Pros and Cons of the proposed policies

(Do a general pros and cons analysis of the proposed policy)

Conclusion

(In one paragraph, remind the reader that the problem is significant and is related to social, economic, and environmental injustice, and in another paragraph show how the proposed solution is or is not a fair, just, and effective way to advance human rights.)

List of References

Angell, T. (2018, July 11). Medical Marijuana Reduces Opioid Prescriptions, Another Study Finds. Retrieved November 2, 2018, from https://www.forbes.com/sites/tomangell/2018/07/11/medical-marijuana-reduces-opioid-prescriptions-another-study-finds/#45286c6b0020

Borchardt, J. (2018, May 03). Gov. John Kasich proposes new opioid rules for chronic pain patients. Retrieved October 27, 2018, from https://www.cleveland.com/metro/index.ssf/2018/05/gov_john_kasich_proposes_new_o.html

Dermer, D. (2018, November 05). Ohio likely to consider medical marijuana for opioid addiction - The Boston Globe. Retrieved November 2, 2018, from https://www.bostonglobe.com/news/marijuana/2018/11/05/ohio-likely-consider-medical-marijuana-for-opioid-addiction/9mHiXxDZXrRWFALWpiPaHP/story.html

Ferrise, A. (2018, May 22). Have opioid deaths in Northeast Ohio finally crested? Evidence suggests yes. Retrieved October 30, 2018, from https://www.cleveland.com/metro/index.ssf/2018/05/have_opioid_deaths_in_northeas.html

Governor's Cabinet Opiate Action Team About. (n.d.). Retrieved October 30, 2018, from http://fightingopiateabuse.ohio.gov/About

U. (2017, March 30). Ohio limits opioid prescriptions to just seven days. Retrieved from https://www.nbcnews.com/storyline/americas-heroin-epidemic/ohio-limits-opioid-prescriptions-just-seven-days-n740531

Overdose Prevention. (n.d.). Retrieved October 29, 2018, from http://opiatecollaborative.cuyahogacounty.us/en-US/Project-DAWN.aspx

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