The NCSL Blog


By Kate Blackman

Drug overdose deaths appear to have reached a record high in 2017, according to new data from the Centers for Disease Control and Prevention.

Bottle of pillsThe data is provisional as some deaths are still being investigated and may indicate an underreporting, but the prediction estimates around 72,000 deaths involving prescription and illicit opioids as well as other drugs—an increase of roughly 6 percent from 2017.

Nearly every state legislature across the country is considering approaches to address the persistent crisis. Following on the heels of active 2016 and 2017 legislative sessions, state lawmakers in 2018 continued along their determined path.

Legislatures in 45 states considered more than 480 bills in 2018 related to health policies to prevent and intervene in opioid misuse and overdose, according to NCSL’s tracking.

This tracking does not include treatment or recovery strategies, or criminal justice or child welfare issues, which are also areas of significant legislative interest and activity. The total includes new legislation as well as a number of bills from 2017 that were still active in state legislatures that meet throughout the year and those that carry legislation over from the odd-numbered to the even-numbered year.

So far, around 70 bills have been enacted or adopted. NCSL rounds up the trends and highlights from our 2018 legislative tracking in six categories of opioid-related health policy.

Prescription drug monitoring programs. Prescription drug monitoring programs (PDMPs) were the most active area of legislation again in 2018, with nearly 100 bills introduced and more than 20 enacted. Nearly all states operate PDMPs—electronic databases that track prescriptions—and current legislative efforts largely adjust different aspects of the PDMP. Lawmakers most commonly changed provisions to require prescribers and/or dispensers to access the PDMP before prescribing and/or dispensing certain controlled substances. Other issues included data sharing and confidentiality, PDMP prescribing reports or “report cards” for providers and veterinarian use of the PDMP.

Naloxone access. Legislative activity around access to the overdose reversal drug naloxone ranks just behind PDMPs. Policymakers largely continue to expand the types of individuals who can carry and administer naloxone, as well as allowing greater access through standing orders, i.e., prescriptions for large groups, such as an entire state, or allowing pharmacists to prescribe and dispense the opioid antagonist. Some states—such as Arizona and Rhode Island—passed provisions related to co-prescribing naloxone when prescribing opioids. In addition to these bills, many states also adjusted laws providing limited immunity for assisting in the event of an overdose.

Prescription limits or guidelines. Limits on days of supply or dosage for opioid prescriptions emerged as a trend in 2016 and immediately surged—jumping from eight states in 2016 to at least 33 states in summer 2018. Nine states—Arizona, Colorado, Florida, Missouri, Nebraska, Oklahoma, South Carolina, Tennessee and West Virginia—enacted these laws in 2018. While some states direct or authorize specific entities, e.g., department of health, to set limits, the majority of these provisions limit initial prescriptions for acute pain and allow exceptions for chronic pain, hospice care and cancer care, among others. Relatedly, a number of states have considered and enacted requirements for practitioners to discuss the risks related to opioid use when issuing prescriptions.

Provider education. Legislatures in 12 states enacted policies related to health care provider continuing education. Policymakers largely continued along similar paths to prior years, passing provisions requiring continuing education for health care providers related to substance use disorder or addiction, and opioids and prescribing controlled substances.

Pain clinics/pain management. Laws related to pain clinics—facilities that specialize in treating chronic pain—continue to garner less attention, and activity is similar to a year ago with less than five bills enacted this year. State legislators largely continued to adjust registration and licensure requirements for pain management clinics.

Other topics. This category includes a wide variety of policies. Some of the more novel approaches include Rhode Island’s law allowing for fentanyl test strips to check drugs for the powerful synthetic opioid that can be mixed with other drugs without a user’s knowledge and is causing an increasing number of deaths. Rhode Island and West Virginia also joined the handful of other states recently providing for voluntary non-opioid directives for patients. Other laws enacted so far this year cover topics ranging from disposal of unused opioids and warning labels or red caps on opioid prescriptions, to opioid education in schools and the creation of opioid committees or task forces.

We anticipate that these issues will remain at the forefront of state legislatures, as policymakers continue to adjust existing policies and develop innovative new solutions. Keep track of these and other developments this year through NCSL’s legislative tracking and opioid policy deep dive webpage.

Kate Blackman is a program director in NCSL’s Health Program. Amber Bellazaire and Charlie Severance-Medaris contributed to this blog post.

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About the NCSL Blog

This blog offers updates on the National Conference of State Legislatures' research and training, the latest on federalism and the state legislative institution, and posts about state legislators and legislative staff. The blog is edited by NCSL staff and written primarily by NCSL's experts on public policy and the state legislative institution.