States Implement Policy Measures in 2016 to Address Opioid Misuse
ASTHO tracked legislation across the 48 jurisdictions that held legislative sessions in 2016 to identify the actions policymakers are taking to protect public health. Opioid overdose deaths continue to rise in the United States, and according to CDC, 91 Americans die every day from an opioid overdose. This year, legislatures focused on finding effective solutions to this ongoing epidemic by adopting statutory and regulatory limits on opioid prescriptions and expanding safe syringe access programs.
Supply and Dosage Limits
States hope that placing dosage limits on opioid prescriptions for patients experiencing non-surgical, acute pain will help alleviate the overdose epidemic. Connecticut, Maine, Massachusetts, New York state, Pennsylvania, and Rhode Island enacted laws to limit the amount of opioids that can be prescribed, while Vermont and Arizona implemented similar supply and dosage limits through rulemaking and executive orders.
Massachusetts and New York state established a seven-day supply limit for initial opioid prescriptions, and Pennsylvania prohibited healthcare providers from prescribing more than seven days of opioids for patients who seek treatment in an emergency room or urgent care center, or who are under hospital observation. Additionally, Pennsylvania now prohibits providers from refilling opioid prescriptions in those locations.
Maine and Rhode Island both used a maximum morphine milligram equivalent (MME) as part of their approaches to limit the amount of opioids that can be prescribed. In Maine, the maximum is 100 MME per day, and there is a 30-day supply limit for chronic pain and a seven-day supply limit for acute pain. In Rhode Island, there is a 30 MME daily maximum and a 20 dose limit for initial opioid prescriptions for adults. States may make exceptions to the dosage limits for cancer care and treatment, palliative care, and hospice care. Maine also authorized the health department to identify other exceptions, and Pennsylvania allows exceptions when in the best medical judgment of the provider.
The Vermont Department of Health proposed a rule that establishes a 24 MME daily dose, with the length of the prescription varying based on the severity of the pain or condition being treated. For example, a minor or moderate injury will be treated with a three-day prescription, while a more severe injury will have a five- to seven-day prescription. While the rule prohibits opioid prescriptions in excess of 50 MME per day, providers can prescribe opioids in higher amounts or for longer durations if they document the medical rational in the patient’s record. Arizona’s governor signed an executive order to limit initial opioid prescriptions to seven days in the state’s Medicaid system and the state employee insurance program. Whether through legislative and regulatory measures, or executive actions, states can leverage a range of authorities and policy approaches to address opioid prescribing practices and guidelines.
Safe Syringe Access Programs
States began authorizing syringe services programs (SSPs) in 1990, despite broad resistance and restrictions that historically have limited the types of program activities that can be conducted with federal funding. In 2016, two factors led states to adopt and expand SSPs: (1) Congress removed a funding restriction to allow federal funds to support the administrative costs of SSPs, and (2) syringe sharing tied to increasing rates of opioid misuse threatened progress in reducing transmission of HIV and other blood-borne diseases. North Carolina and Utah passed laws in 2016, authorizing the establishment of SSPs in their states, and Florida created a pilot SSP in Miami-Dade County. In addition, Connecticut, Delaware, Maine, and Maryland authorized statewide SSPs. To learn more about how states are expanding access to safe syringes, the Policy Surveillance Program at Temple University has an interactive tool highlighting different approaches across the country.
State and territorial health officials can play a key role in championing the adoption and implementation of evidence-based policies and programs to combat opioid abuse and misuse. ASTHO’s 2017 President’s Challenge—Public Health Approaches to Preventing Substance Misuse and Addictions—brings a multi-level framework emphasizing prevention and early intervention to address substance use disorders and their related consequences. Key strategic priorities include reducing stigma and changing social norms, increasing protective factors and reducing risk factors in communities, strengthening multisectoral collaboration, improving prevention infrastructure, and optimizing the use of cross-sector data for decisionmaking. To learn more about this initiative, see the President’s Challenge Factsheet.
KT Kramer, JD, MHA is ASTHO’s director of state health policy. She supports state and territorial health agencies to advance and strengthen public health
through laws and policies.