PRESCRIPTION DRUG MISUSE & ADDICTION – LEGISLATIVE TRENDSSusan AwadAmerican Society of Addiction Medicine
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.
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
Administrative rule increases patient limit to 275 Qualify via board certification or practice setting Annual reporting requirements & 3-year renewal
Grants to fund treatment
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)
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.
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.
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.
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.