State Opioid Response Plans for 2018

December 21, 2017|1:23 p.m.| ASTHO Staff

As state and territorial legislatures prepare for their 2018 sessions, addressing substance misuse and addiction, especially opioids, is likely to be a top priority. Throughout 2017, at least nine states instituted strategic planning processes, legislative study committees, and executive task forces and budget proposals to develop strategies, recommendations, and action plans to respond to the opioid epidemic. These plans provide insight into the priorities for and direction of substance use policies we will likely see in the coming year.

In August 2017, Alabama Gov. Kay Ivey established the Alabama Overdose and Addiction Council, co-chaired by the state health officer, the commissioner of the Department of Mental Health, and the attorney general, including representatives from the state’s executive, legislative, and judicial branches, healthcare professions, and community members. The council is expressly tasked with developing a strategic action plan that includes policy, regulatory, and legislative recommendations for abating the opioid crisis in Alabama. The deadline for the council’s recommendations is Dec. 31, 2017, and are likely to inform the state’s future policy response to drug overdoses and substance use disorders.

In response to Arizona Gov. Doug Ducey’s public health emergency declaration for opioids this past summer, the Arizona Department of Health Services developed an action plan to address opioid-related deaths. The plan included 16 state-specific legislative recommendations with the following four identified as high-impact:

  • Limiting first fills for opioid naïve patients to five days.
  • Requiring red caps or different labels and packaging for opioids.
  • Regulating pain management clinics.
  • Enacting good Samaritan laws to encourage bystanders to call 911 in the event of a potential overdose.

In addition, the plan includes efforts that the federal government could undertake to remove barriers, such as removing regulatory restrictions that impede sharing substance use disorder data, that inhibit Arizona’s capacity to address the epidemic.

In April 2017, the Colorado legislature authorized the Opioid and Other Substance Use Disorders Interim Study Committee to “study prevention, intervention, harm reduction, treatment, and recovery support strategies for opioid and other substance use disorders.” The study committee brought together ten members of the state legislature, as well as a task force to hear from stakeholders with expertise on the opioid issue. The committee produced its final report this month, which recommends that six bills be considered in 2018, focusing on:

  • Preventing opioid misuse, promoting clinical practices for safe opioid prescribing, and establishing the committee as a year-round committee through 2020 with authority to refer up to six bills annually.
  • Piloting a syringe services programs and authorizing access to opioid antagonists in schools.
  • Extending existing student loan repayment programs to and establishing a scholarship program for behavioral health providers.
  • Adding coverage for inpatient and residential substance use disorder treatment to the Medicaid program, conditioned on federal approval.
  • Modifying insurance coverage requirements to increase availability of non-opioid alternatives for pain management and medication-assisted treatment.

In September 2017, Florida Gov. Rick Scott announced he would propose legislation and more than $50 million to address opioid misuse in his 2018-2019 budget recommendation. The funding would be used for substance use disorder treatment and counseling and recovery support services, as well as support for local and state law enforcement initiatives. Specific policy proposals from the Gov. Scott include:

  • Limiting opioid prescriptions to three days unless strict criteria for medical appropriateness are met.
  • Mandating participation in the state’s prescription monitoring program for all prescribers and dispensers and requiring continuing education courses on appropriate opioid prescribing.
  • Providing new tools to address unlicensed pain management clinics.
  • Creating opportunities for federal grant funding.

In advance of the 2018 session, a bill (HB 21) was pre-filed in the Florida House of Representatives incorporating many of the governor’s recommendations.

In April 2017, the Governor’s Office of Drug Policy in Idaho convened a planning group to develop the Idaho Opioid Misuse and Overdose Strategic Plan 2017-2022. Over 40 stakeholders came together and identified the critical success factors, goals, strategies, and performance measures to achieve “a safe and healthy Idaho, free of opioid misuse and untreated opioid use disorders.” The plan organized the goals into four critical success factors:

  • Educating providers, patients, and the public.
  • Improving opioid prescription practices.
  • Strengthening and supporting families.
  • Expanding awareness of and access to treatment.

The strategies build on the existing efforts and infrastructure within Idaho, as well as identify new opportunities, such as interdisciplinary efforts to support substance use disorder treatment for justice-involved populations and implementing Project ECHO models to support providers who treat patients for chronic pain, as part of a multi-faceted response. Although the plan does not specifically identify legislative proposals, public health legal interventions could support the strategies.  

Illinois Gov. Bruce Rauner released the Illinois Opioid Action Plan in September 2017, outlining a goal of reducing opioid-related deaths by 33 percent in three years. The foundation of the plan rests on the pillars of prevention, treatment and recovery, and response, each of which have priority areas and strategies. Although the plan does not identify specific policy proposals, its recommendations include improving data-sharing and integration, eliminating barriers to medication assisted treatment and other recovery services, and addressing opioid use disorders and overdoses in justice-involved populations, which could require legislative, regulatory, or sub-regulatory changes to implement effectively.

In May 2017, Indiana Gov. Eric Holcomb released A Strategic Approach to Addressing Substance Abuse in Indiana that identified five key strategies to “respond to the current opioid crisis and enhance the potential for timely responses to future crises resulting from substance abuse and addictions.” These key strategies include:

  • Reducing the incidence of substance use disorder.
  • Reducing the harm that can result from substance abuse.
  • Improving treatment of persons with substance use disorders.
  • Developing and augmenting the ability of the Executive Director for Drug Prevention, Treatment, and Enforcement to serve its stakeholders.
  • Supporting and enhancing substantial community-based collaboration aimed at prevention, treatment, and recovery.

To complement the strategic approach, the Indiana Executive Director for Drug Prevention, Treatment, and Enforcement identified initial steps and activities aligned with the strategic goals. In addition to implementing legislative and regulatory changes made during 2017, the action plan includes investigating new policy opportunities, such as a centralized procurement and distribution system for opioid antagonists, loan repayment programs for substance use disorder treatment providers, and alternative pain management protocols for providers. Developing and implementing these proposals will likely require policy changes in 2018.

North Carolina released its Opioid Action Plan in June 2017. The plan was developed through a collaborative process managed by the state’s Prescription Drug Abuse Advisory Committee (PDAAC). The action plan is structured around seven focus areas, including:

  • Creating a coordinated infrastructure.
  • Reducing the oversupply of prescription opioids.
  • Reducing diversion of prescription drugs and flow of illicit drugs.
  • Increasing community awareness and prevention.
  • Making naloxone widely available and link overdose survivors to care.
  • Expanding treatment and recovery oriented systems of care.
  • Measuring the impacting and revising strategies based on results.

Each focus area includes specific strategies, detailed actions, and assigns leads to spearhead the work from PDAAC’s members. There are also identified metrics to evaluate the impact that the plan is having on substance use in the state. Several of the action items include policy changes such as state funding increases for treatment, improving services for justice-involved populations, and establishing a standardized data collection systems, which could generate legislative or regulatory proposals.

In November 2017, Montana finalized Addressing Substance Use Disorder In Montana, which was developed through a participatory process that included 114 individuals representing 82 organizations and entities. The overall goals for the plan are reducing overdose deaths, decreasing the number of Montanans who misuse or abuse substance, and increasing the number of Montanans who receive treatment for substance use disorders by focusing on partnerships, prevention and education, enforcement, treatment, and family and community resources. The plan includes five focus areas—partnerships, prevention and education, enforcement, treatment, and family and community resources—with unique goals, metrics, key actions, strategies, and leads for each one. Several activities, including developing data-sharing memoranda of understanding, establishing a state-wide standing order for opioid antagonists, and strengthening treatment for justice-involved populations will likely require policy changes in the new year.

It is clear that policymakers across the country are preparing to build on existing laws, partnerships, and programs, as well as create new ones, to stem substance use, dependency, and addiction. Throughout 2018, ASTHO will track these and other public health policies, share best and emerging practices, and advocate with federal partners for increased support and resources as state health departments undertake these vital efforts.