State opioid measures aim to address opioids as deaths continue to rise

Sunday, June 3, 2018 9:58 PM
The Colorado Legislature is aiming to help prevent addiction to painkillers such as hydrocodone. Opioids, including heroin, are responsible for a rising number of deaths in the state.

New state laws seek to prevent patients from developing an opioid addition, expand access to addiction treatment and direct lawmakers to continue studying the problem for two more years.

The scope of the opioid problem helped unite the Legislature around six bills that passed this session, said Joe Hanel, a spokesman for Colorado Health Institute.

“Way more people are dying from drug overdoses than they are from car accidents,” he said.

In 2017, there were more than 1,000 drug overdose deaths in Colorado, and 558 of them were related to opioids or heroin, according to provisional data from the Colorado Department of Public Health and Environment. In 2016, there were about 500 deaths in the state related to opioids or heroin.

Gov. John Hickenlooper recently signed five of the bills; the sixth awaits his signature or veto.

Several of the new bills are expected to impact how substance abuse treatment is provided in Southwest Colorado, said Mary Dengler-Frey with the Southwestern Colorado Area Health Education Center.

“Overall, the effect (we hope) will be that the stigma around addiction as a disease, and the treatment of addiction, will be reduced,” Dengler-Frey wrote in an email to The Durango Herald. Opioid abuse is one of the three biggest health problems facing the region, along with diabetes and suicide, according to AHEC.

Experts describe the measures as a good start, but reversing the rising wave of fatal overdoses could take years.

Many of those who are overdosing now started taking opioids 12 or 15 years ago and their addiction worsened gradually, said Rob Valuck, director of the Colorado Consortium for Prescription Drug Use Prevention.

Prevention effortsSenate Bill 18-022 limits the number of opioid painkillers, such as oxycodone, that doctors, dentists, optometrists and other health care providers can prescribe initially to a week-long dose. It was common for physicians to prescribe 30 or 60 pills to patients. Leftover medication can lead to addiction later, Valuck said.

The law makes exceptions for those who have cancer and those who experience post-surgical pain expected to last longer than two weeks.

At Mercy Regional Medical Center and Southwest Health System in Cortez, doctors started to limit their opioid prescriptions before the new law was signed.

Expanding treatmentHouse Bill 18-1007 requires insurance companies to allow patients to start medication-assisted treatment without waiting days or weeks for approval.

“Their physical addiction is going to make it really impossible to wait that long,” Hanel said.

In Southwest Colorado, Dengler-Frey is training physicians to provide these treatments. So far, she said, interest is strong.

Training primary care doctors to provide this medication-assisted care is key because there are so few doctors who specialize in treating addiction, Valuck said. About 500 primary care providers have been trained in Colorado. The consortium wants thousands more to take the day-long training required to treat opioid addiction.

Another bill, Senate Bill 18-024, could bolster the behavioral health workforce. It will offer loan repayment programs to those in the behavioral health field who commit to work in rural areas and other workforce shortages areas.

Medicaid-funded treatmentExperts say House Bill 18-1136 could have a huge impact in combating additions related to opioids, alcohol and other substances. It would allow Medicaid patients to seek inpatient and residential substance-use treatment. Right now, Medicaid covers only detox and outpatient treatments, Valuck said. The bill was passed by the Legislature, but it has not been signed by the governor.

It could take two years to set up the new Medicaid service. The state would spend about $35 million on the program during its first year and the federal government could provide $128 million, according to state documents. Other states, including Utah, have been approved for similar federal funding, Valuck said.

For every $1 spent on inpatient substance-abuse treatment through Medicaid, $12 spent on medical care and law enforcement could be saved, Valuck said.

“It’s just a glaring need,” he said.

Medicaid funding could encourage new inpatient treatment centers to open, and in rural areas, hospitals could set aside space and beds for inpatient treatment, he said.

Ongoing effortThe Legislature plans to study the issue for at least two more years. House Bill 18-1003 directs lawmakers to continue studying the scope of the problem, steps other states are taking and strategies to keep those with an addiction from harming themselves.

In the future, the Legislature is also likely to consider regulating sober-living homes because they are an unregulated industry and there have been some bad actors, Valuck said.

“You hear stories about some of them being kind of scary,” he said.

The Denver Post reported in March that the founder of a recovery home company was convicted for sexually assaulting or exploiting seven patients and offering them controlled substances.

The Legislature will likely also examine how to reduce the harm associated with drug use, Hanel said.

For example, needle exchanges and supervised injection facilities can help the spread of disease, such as hepatitis C.

Injection facilities allow visitors to use illicit drugs in a professionally staffed center without the threat of arrest. The facilities typically offer education about health care, treatment referrals and access to medical staff, according to the Drug Policy Alliance.

A pilot program for a supervised injection facility was proposed in the state Legislature this year, but the idea proved to be too controversial, Hanel said.

Ideas behind the new bills were generated by stakeholder groups that included law enforcement officers, treatment providers, public health professionals and others, Valuck said. He expects to build on the recent progress in the Legislature.

“We want to keep this process going,” he said.