Hitting Utah’s Opioid Epidemic from Multiple Angles

April 25, 2016|10:25 a.m.| KT Kramer

In 2014, more people died from opioid overdoses than from car crashes in the United States. During the 2016 legislative session, Utah enacted nine bills to provide more tools and flexibility to respond to this epidemic. Support for the new laws was far-reaching, with organizations including the Utah Medical Association, the Worldwide Organization for Women, Utah Naloxone, and the Utah Department of Health, as well as private individuals testifying on behalf of the bills. As described by Representative Steve Eliason, these bills “form a nice tapestry in terms of hitting at different angles” of the epidemic.

Leveraging the Controlled Substances Database

In 1995 Utah created the Controlled Substances Database (CSD), a prescription drug monitoring database housed within the Department of Commerce’s Division of Occupational and Professional Licensing (DOPL). Over the past decade, it has fine-tuned the database to improve its effectiveness, for example, by ensuring timely data submission. This trend continued in 2016, with several pieces of legislation modifying the CSD to improve information sharing across sectors and among stakeholders engaged with substance abuse issues.

HB 114 and HB 149 requires that hospitals report admissions due to overdoses, the Administrative Offices of the Courts report convictions of certain controlled substances offenses, and medical examiners report deaths attributed to overdoses to the CSD. SB 136 also provides medical examiners with statutory access to the CSD. By consolidating relevant information on opioid use and overdoses from different sources, “[the hope] is that physicians and pharmacists can then realize when somebody is in trouble and make a smarter decision or intervene to help that person get out of an addiction before it gets too difficult.” (Quoting Representative Raymond Ward, sponsor of HB 114)

HB 239 and HB 150 start important conversations about leveraging the CSD to support clinical practice for providers and for individuals overcoming substance abuse. HB 239 tasks DOPL with integrating the CSD with data systems—such as electronic health records—that physicians and pharmacists use in clinical practice. Although developing secure and user-friendly interfaces across different platforms is a tall order that will take time, the new law begins a vital process to improve the safety of prescribing. HB 150 allows individuals to request that DOPL inform a designated third party whenever a controlled substance prescription is dispensed. Representative Brad Daw, who sponsored the bill, explained his goal is that “addiction counselors, family, and friends … can take part in helping a person recover from an addiction.” Both of these bills incorporate security features to balance expanded data sharing and access with patient protections and privacy.  

Creating Flexibility to Respond

Utah also expanded access to opioid antagonists, like Naloxone, by allowing more individuals and entities to administer them, establishing a process for standing orders, and providing funding for a comprehensive public health approach. HB 238 authorizes “overdose outreach providers” to furnish or administer opioid antagonists in addition to healthcare providers. Overdose outreach provider is defined expansively to “[get] this lifesaving drug to outreach providers who are on the frontlines.” (Quoting Representative Carol Spackman Moss, sponsor of HB 238) Additionally, HB 238 requires more specific education for recognizing and responding to overdose symptoms, administering opioid antagonists safely, and the need to seek emergency medical care immediately after reversing an overdose.

Under HB 240, “a physician licensed in the state, including a physician acting in the physician’s capacity as an employee of the [health] department, or a medical director of a local health department” can issue a standing prescription drug order for opioid antagonists. To ensure that the authority granted under standing orders is used appropriately, HB 240 includes oversight and reporting requirements including specifying individuals authorized to dispense under the standing order by their professional license numbers and requiring annual reviews of dispensing practices under the order. Additionally, HB 192 appropriates $250,000 to support a public health approach to the issue. In addition to a pilot program to fund the purchase of opioid antagonists by community groups, local government, and emergency services providers, HB 192 supports public health interventions like public awareness campaigns, developing educational resources, and updating the state’s Clinical Guidelines on Prescribing Opioids.

Finally, HB 308 allows a variety of organizations to operate syringe exchange programs, including governmental health departments and nonprofits. The law requires that people who exchange syringes receive verbal and written information on disease prevention and testing, accessing opioid antagonists, and options for substance abuse treatment. Additionally, the law establishes reporting requirements, which will allow the Department of Health and the legislature to evaluate and modify these programs over time.  

Utah’s efforts illustrate the need for comprehensive strategies and an integrated systems approach to address the opioid overdose epidemic. The new laws build on existing programs and resources at the Utah Department of Health and pave the way for new solutions. See how other states and territories are tackling this crisis through legislation at ASTHO’s State Legislative Tracking page, and through interventions and prevention activities at ASTHO’s Prescription Drug Misuse and Abuse page.

KT Kramer

KT Kramer, JD, MHA is ASTHO’s director of state health policy, where she supports state and territorial health agencies to advance and strengthen public health through laws and policies. KT owes many thanks to the staff at the Utah Department of Health for their insight and input in conceptualizing and drafting this article.