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What is an opioid?
Opioids are a class of drugs that include the illegal drug heroin, synthetic drugs such as fentanyl, and pain relievers available legally by prescription, such as oxycodone, hydrocodone, codeine, morphine and many others. (Source: National Institute of Drug Abuse)
What are signs of abuse?
According to the Colorado Department of Public Health and Environment:
• Any use of heroin is considered abuse.
• Taking prescription pain medications after the pain is gone.
• Seeking prescriptions for a condition you no longer have.
• Taking pills prescribed for someone else.
The Colorado lawmakers behind the proposals explain the bills:
Amid opioid epidemic, six Colorado proposals could fight trend
One Coloradan died approximately every 27 hours on average from a prescription opioid-related overdose in 2015, according to Colorado Department of Public Health and Environment data. While that death toll dropped by 9 percent in 2016, the number of heroin-related overdose deaths increased 43 percent.
“Right now, we’re seeing about 60 percent of overdose deaths due to pills, with about 40 percent due to heroin,” said Robert Valuck, director of the Colorado Consortium for Prescription Drug Abuse Prevention. “Heroin is making a comeback.”
“Overdose deaths across the nation have doubled in the past 15 years,” said Lindsey Myers, the Colorado Department of Public Health and Environment’s violence and injury prevention branch chief.
The increase in deaths over the long term has led lawmakers in all states to examine ways to combat the problem.
Colorado’s legislative Opioid and Other Substance Use Disorders Interim Study Committee recently voted to move forward with a six-bill package of legislation, aimed to help treat, prevent and intervene if possible when opioid addiction occurs.
Will the legislation help? The following is a look at what some area health-care professionals have to say.
• One bill proposes to “create training programs for health professionals, law enforcement and at-risk communities for safe opioid prescribing, medication-assisted treatment and overdose prevention.”
“Historically, doctors refer patients out for substance-abuse disorders,” Valuck said. “We really need doctors and physician assistants to take responsibility for their patients, and treat their disorder as they would any other disease.”
According to Valuck, physicians and health-care providers could benefit from learning more about medication-assisted treatment and utilizing that treatment with their patients.
• Another bill would limit most opioid prescriptions to a seven-day supply for acute conditions, and, in many cases, mandate that medical professionals check the Prescription Drug Monitoring Program database before writing prescription refills.
Dr. John Douglas, executive director of the Tri-County Health Department, which serves Adams, Arapahoe and Douglas counties, said restricting prescriptions for acute conditions could be effective.
“I actually think it’s a very good idea. The vast majority of acute pain won’t need more than seven days (worth of treatment),” Douglas said. “Sometimes, not even that is necessary. Combining certain drugs, which are not opiates, can sometimes work better.”
The part of the bill that would require medical professionals to check the PDMP database could pose a problem, according to Myers. Pharmacists are required to update the system every time they fill a prescription for narcotics, so in theory every physician could pull up their patient and assess their history.
In reality, the current PDMP system is underutilized by physicians because it is cumbersome and takes too much time to deliver the information, Myers said.
“I think providers want to use the system, but it’s underutilized in Colorado,” she said. “The main reason is it is a system that lives outside the workflow of providers. But we are pilot testing ways to make the system easier to incorporate into records.”
• A third bill would pave the way for a pilot project for a supervised injection facility in Denver.
Offering a safe place, supervised by medical professionals, for addicts to inject may seem radical, but according to Valuck, such places work.
“Supervised injection facilities work, we are in support of them,” he said. “First and foremost, these are human beings. Everyone knows someone with a substance use disorder. Secondly, SIFs decrease the spread of disease, such as HIV and hepatitis. These diseases put first responders and physicians at risk.”
Tri-County Health already supports a syringe-access facility in Aurora, which has served about 150 clients within its first year. The program is a street-based program, and those with substance-abuse disorders can exchange dirty needles for clean ones, Douglas said.
• Another of the bills proposes to expand the Colorado Health Services Corps program. The program currently includes financial incentives for health care professionals who agree to work in underserved areas. Historically, the program has only included physicians.
“It would now include substance abuse counselors through Colorado Health Services Corps,” Myers said. “The new bill would expand program to incentivize people to move and work in areas where there are not addiction counselors.”
• A fifth measure would significantly increase access to residential treatment to qualifying people with substance-use disorders.
One of the biggest problems is a lack of treatment for substance-abuse disorders, Valuck said.
“We are at about an 85 percent treatment gap,” Valuck said. “The state would have to come up with money to help pay for residential treatment.”
• The final bill would improve “prior-authorization” standards to ensure insurance companies and Medicaid give timely approval for medication-assisted treatment. This bill also aims to reduce copays for physical therapy, acupuncture and chiropractic alternatives to narcotics.
“This is really a good start,” Valuck said. “We have to shift the language, and the way we think of people with substance-use disorders.”
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