By Kate Blackman
As overdose deaths from opioids—including prescription drugs—continue to rise, strategies to confront the epidemic are likely to stay at the forefront during the 2017 legislative sessions.
Legislators considered at least 536 bills across 47 states related to prescription drug abuse prevention in 2016, according to NCSL’s tracking. Highlights of 2016 state legislation in six policy areas tracked in NCSL’s Injury Prevention Database follow, with every indication that 2017 will see similar legislative action.
One of the biggest headlines in substance misuse legislation last year came from Massachusetts’ comprehensive legislation, which made it the first state to enact prescribing limits. Seven states followed shortly thereafter—Connecticut, Maine, New Hampshire, New York, Pennsylvania, Rhode Island and Vermont. Arizona joined this list by executive order.
Most of this legislation limits first time opioid prescriptions to seven days, with some exceptions, such as for cancer and palliative care. New Hampshire, Rhode Island and Vermont’s legislation, and Arizona’s executive order, direct other entities to establish limits.
A handful of other states have adopted guidelines similar to these limits. In addition, the Centers for Disease Control and Prevention (CDC) released its Guideline for Prescribing Opioids for Chronic Pain in March 2016, which are a voluntary set of recommendations for providers.
Prescription Drug Monitoring Programs
Forty-nine states, the District of Columbia and Guam operate prescription drug monitoring programs (PDMP)—state electronic databases that track prescriptions of controlled substances, including opioids.
Many of the 53 bills enacted in 2016 focused on making changes to PDMPs, such as who is required to register with the PDMP, who is allowed to access the PDMP, and how often data must be reported.
A number of states tackled mandated use—when a practitioner is required to check the database before prescribing or dispensing an opioid. For example, states including Alaska, California, Maine, Maryland, New Hampshire, Utah and Wisconsin established new requirements and a number of other states amended their requirements.
This category captures action related to so-called rescue drugs—overdose reversal drugs (i.e., naloxone). In 2016, more than 40 bills were enacted in this arena, most commonly to increase access to naloxone. States addressed standing orders and allowing pharmacists to dispense naloxone without a prescription, and made changes to those who are allowed to carry or use naloxone, such as family and friends, school personnel, law enforcement and emergency/first responders.
Policymakers also addressed immunity for those who dispense naloxone, use it to reverse an overdose for another person, or for those who call 911 in the event of an overdose emergency. NCSL’s criminal justice program covers naloxone and Good Samaritan laws closely and also has information on recent trends in state drug crime policy.
Provider training was a new category for NCSL’s tracking in 2016, and at least 11 bills were enacted in nine states. These laws typically require certain providers to have training or continuing education in prescribing controlled substances, and/or require training or education in pain management.
As with the other categories, variation exists among states. For example, in addition to mandating licensing boards to require two hours of continuing education in pain management, addiction or prescribing and dispensing opioids for licensure renewal, Pennsylvania also required implementation of “a safe prescription of a controlled substance containing an opioid curriculum.” While it is not required for graduation, the legislation stipulated that the curriculum may be offered in colleges.
NCSL tracks legislation that regulates pain clinics—facilities that specialize in treating chronic pain—as well as bills that overlap with chronic pain management more generally.
At least 17 bills were enacted or adopted in 2016 related to pain clinics and pain management, most related explicitly to pain clinics. For example, Florida amended physician prescribing responsibilities in pain clinics, Tennessee established licensure and certificate of need requirements, and Wisconsin created certification and other requirements. On another note, Vermont and Massachusetts included provisions related to alternative pain management treatments (such as chiropractic, acupuncture and massage).
States enacted or adopted at least 55 bills related to other substance misuse prevention topics such as: task forces, commissions or councils; drug “take-back” days or programs; insurance coverage for abuse-deterrent opioids; grants and funding; and public education programs and other educational efforts.
This session, stay up to date on the newest introduced and enacted legislation on prescription drug abuse prevention through NCSL’s Injury Prevention Database. You can search the database by each of the categories above, and filter to include all introduced legislation or just enacted bills.
NCSL also tracks other injury issues from a prevention angle: child abuse and neglect; traumatic brain injury; teen dating violence and older adult falls. Find out more about the 260 bills that legislators considered in 2016 these categories in our recent blog.
Kate Blackman covers public health issues in NCSL’s Health program.