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Tue March 11, 2014
RI Lawmakers Mull New Drug Abuse, Overdose Bills
The Senate Health and Human Services committee will be considering a suite of proposed bills that aim to tackle the state's prescription painkiller and heroin addiction and overdose crisis.
The committee's chair, Senator Joshua Miller (D-Dist. 28, Cranston, Providence), plans to introduce several of those bills, including:
- A measure that would require health insurance coverage for Narcan, which is an antidote to opioid overdose. He also wants insurers in the state to cover buprenorphine, which is used to treat addiction to opioids like OxyContin and heroin. And he also wants health care providers to provide patients with substance abuse problems with a treatment plan, including up to the minute information on which treatment beds are available, for instance, if the health care provider thinks the patient needs in-patient treatment. I am curious about how health care providers might respond to that kind of requirement.
- 2014-S 2534 – Another bill sponsored by Chairman Miller that would prevent insurance policies from requiring that patients try an opioid painkiller first, before trying something less addictive.
- 2014-S 2523 – This bill, sponsored by Sen. Christopher Scott Ottiano (R-Dist 11, Portsmouth, Bristol) would let health care providers other than a patient's doctor or pharmacist access a patient's records in the state's prescription drug monitoring program.
A couple of other bills are under consideration as well concerning opioid addiction and overdose.
No word on when hearings about these bills will be scheduled. But here's some background about the issues each bill seeks to address:
- Covering Narcan and Suboxone: Right now, Narcan requires a prescription, but in Rhode Island, Dr. Jody Rich has agreed to be the standing prescriber so that anyone can go into a Walgreens pharmacy and buy the drug. It costs about $25 for the injectable version, about $45 for the nasal spray. A researcher told me that the price of the drug has doubled in the last few years, and there's only one manufacturer. So without coverage, people who want to have this opioid overdose antidote on hand will have to pay whatever the going price is.
As for Suboxone (trade name for buprenorphine), it's one of a few drugs doctors use to treat opioid addiction. Doctors tell me they see far higher success rates for addicts who want recovery when they go on something like Suboxone in addition to other kinds of non-medical therapy. Some people worry about the abuse potential of these drugs, but I hear from addicts and doctors that that potential is fairly low, while the potential for recovery with them is much better.
- Allowing prescribers to prescribe less addictive remedies: I wasn't aware of insurance policies that required patients to try an opioid painkiller first, before trying something else, something less addictive. I'm not sure why that would be, but it seems to me that physicians and other prescribers should be able to use their discretion when it comes to prescribing something for pain, especially given the addictive power of opioids and the availability of other, effective drugs. Whether they're more expensive than opioids, I'm not sure about that either. Anyone want to enlighten me on this point? Please comment!
- Allowing someone other than the doctor to access the prescription drug monitoring database: Only doctors can view someone's record in the prescription drug monitoring program, an online database that tracks patients' prescriptions, where they fill them, and which doctors they've seen to get them. It's supposed to flag troubling behavior like doctor shopping, which could indicate that someone is feeding an addiction. Of course, the system only works if a patient's doctor uses it. And only about 20% of Rhode Island physicians do. And doctors tell me a few things: that logging on and looking up someone's prescription history is great, but it's just one more thing they have to do in a busy day. Why not allow a nurse to gather than information and flag it before an appointment or before refilling a prescription, they say? Also, another doctor told me that once a patient is doctor shopping, he or she is probably already addicted, so the prescription drug monitoring databases that many states have adopted aren't all that useful for preventing addiction, which is part of what they were established for in the first place.