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PRESCRIPTION DRUG MISUSE & ADDICTION – LEGISLATIVE TRENDSSusan AwadAmerican Society of Addiction Medicine
ABOUT ASAM
Source: Park H and Bloch M. How the Epidemic of Drug Overdose Deaths Ripples Across America. The New York Times. Jan 19, 2016. http://www.nytimes.com/interactive/2016/01/07/us/drug-overdose-deaths-in-the-us.html Accessed October 3, 2016.
POLICY TRENDS FEDERAL STATETREATMENT
Medication-Assisted Treatment (MAT)
• Increase patient limit• CARA Sec. 303• Funding
• Clinic regulations• Diversion control
Naloxone • Co-prescribing & standing orders
• Pricing
• Access laws • Good Samaritan
lawsParity • WH Task Force
• New legislation• Implementation &
enforcement
PREVENTION
PDMPs • NASPER reauthorization
• Expanded access• Mandatory
enrollment/ usePrescriber Education
• ER/LA REMS update• CDC Guideline
• Mandatory CME
Quantity Limits • Partial fills• Medicare lock-in
• Partial fills• Prescribing limits
Comprehensive Addiction and Recovery Act (CARA) Expands DATA 2000 prescribing privileges to NPs and PAs Requires updates to 8-hour course and TIP 40 Allows states to add training requirements and lower patient
limit
Administrative rule increases patient limit to 275 Qualify via board certification or practice setting Annual reporting requirements & 3-year renewal
Grants to fund treatment
Medication-Assisted Treatment
Federal
Medication-Assisted Treatment
States
CARA Sec. 107: Grants to FQHCs, OTPs, DATA 2000-waived practitioners
to support naloxone co-prescribing to patient or caregiver ($5m through 2021)
Sec. 110: Grants to states to implement standing orders & encourage pharmacies to dispense naloxone, develop training materials & education public ($5m through 2019)
House Judiciary Committee Hearing: Treating the Opioid Epidemic: The State of Competition in the Markets for Addiction Medicine (Sept. 2016)
FDA Advisory Committee (Oct. 2016)
NaloxoneFederal
NaloxoneStates
Source: National Conference of State Legislatures. Drug Overdose Immunity and Good Samaritan Laws. August 1, 2016. http://www.ncsl.org/research/civil-and-criminal-justice/drug-overdose-immunity-good-samaritan-laws.aspx Accessed October 3, 2016.
Naloxone Access laws may give immunity to prescribers, dispensers and/or lay administrators acting in good faith; allow for layperson distribution and possession w/o Rx; and/or allow for third-party prescribing or standing orders.
Good Samaritan laws may give immunity for bystanders from possession of a controlled substance and/or drug paraphernalia, as well as other offenses such as probation or parole violations.
Mental Health Parity and Addiction Equity Act (2008)
White House Task Force Recommendations due Oct. 31
Legislation Mental Health Reform (H.R. 2646/S. 2680) Behavioral Health Transparency Act (H.R. 4276/S. 2647)
ParityFederal
ParityStates
Source: ParityTrack. Parity Implementation National Survey. Available at: https://www.paritytrack.org/reports Accessed: October 18, 2016.
CARA Sec. 109: NASPER Reauthorization allows funds to be
used to maintain existing PDMP, improve integration with prescriber workflow; requires plan for achieving interoperability with HIT systems, facilitation of prescriber use ($10m/year through 2021)
PDMPsFederal
PDMPsStates
CDC Guideline
Surgeon General “Turn the Tide” Campaign & Report
FDA Opioids Action Plan • “Black Box” warning on opioids,
benzodiazepines• ER/LA REMS Update• CARA Sec. 106: Requires HHS Secretary to
develop recommendations regarding prescriber education on opioids
VA/DOD Guideline update
Prescriber EducationFederal
Prescriber EducationStates
Source: Federation of State Medical Boards. Continuing Medical Education Board-by-Board Overview. Available at: https://www.fsmb.org/Media/Default/PDF/FSMB/Advocacy/GRPOL_CME_Overview_by_State.pdf
State
Details
CA 12 hrs before second license renewal or w/in 4 years
FL Pain mgmt. clinics onlyIA 2 hrs every 5 years
(primary care only)KY 4.5 hrs every 3 years on
PDMP, pain mgmt. or addiction
MD 1 hr on opioid prescribingMA 3 hrs every 2 yearsNC 1 hrNH 3 hrs for initial licensure +
every 2 years
State
Details
NV 2 hrs every other 2 yr cycle
NM 5 hrs every 3 yearsOH Pain mgmt. clinics onlyOK 1 hr every 2 yearsRI 2 hrs – topic optionalSC 2 hrs every 2 yearsTN 1 hr every 2 yearsTX Pain mgmt. clinics onlyVT 1 hr on pain mgmt. + 1 hr
on controlled substances prescribing
WV 3 hrs every 3 years
CARA Sec. 702: Partial Fills of Schedule II Controlled
Substances. Allows for partial fills if requested by patient or prescriber. Remaining portions can be filled within 30 days.
Sec. 704: Medicare Part D Drug Management Program. Allows Prescription Drug Plans (PDPs) to establish patient review and restriction programs (“lock-in” programs) for beneficiaries considered at risk of prescription drug misuse.
Quantity LimitsFederal
Quantity LimitsStates
Source: K.Murphy, M.Becker, J.Locke, C.Kelleher, J.McLeod, and F.Isasi, Finding Solutions to the Prescription Opioid and Heroin Crisis: A Road Map for States (Washington, D.C.: National Governors Association Center for Best Practices, July 2016).
State Type Prescription LimitsConnecticut Statute 7-day limit for new opioid prescriptions for
adults and all opioid prescriptions for minors. Exceptions for chronic and cancer pain, palliative care and clinical judgment.
Illinois Statute Schedule II prescriptions limited to 30-day supply, with exceptions. Permits multiple prescriptions up to a 90-day supply if the prescriber meets specified conditions.
Kentucky Board rules required by statute
48-hour limit on dispensing of Schedule II and III controlled substances by physicians. No limit on opioid prescriptions.
Massachusetts
Statute 7-day limit for new opioid prescriptions for adults and all opioid prescriptions for minors. Exceptions for chronic and cancer pain, palliative care and clinical judgment.
Washington Guideline and board rules required by statute
Pain specialist consultation required prior to prescribing daily morphine equivalent doses of 120 mg or greater, with exceptions.
