December 9, 2018; Arizona Republic
As Linda Valdez writes in the Arizona Republic, there are increasing signs that the state’s declaration of a public health emergency in 2017 and passage of subsequent legislation to address the opioid epidemic has been effective, even if 2018 numbers proving that 2017 was a peak year for overdose deaths will not be available for several months yet. In 2017, 949 Arizonans died of opioid overdoses, a rate of 19 per 100,000 (the national average was 15 per 100,000), and more than twice the state’s fatality rate in 2012. Arizona is one of eight states nationwide to have declared a public health emergency for opioids. (The federal government also made such a declaration.)
Following the state’s public health emergency declaration, the state legislature unanimously passed the Arizona Opioid Epidemic Act of 2018. The law, notes Valdez includes the following provisions:
- Expanded access to naloxone, which reverses the effects of overdoses.
- Medical education for those who either prescribe or dispense opioids.
- A Good Samaritan exception to enable friends and family to call 911 in case of overdose without risking arrest.
- Limits on prescribing opioids to first-time users
These provisions are not as far-reaching as those that NPQ profiled in Dayton, Ohio last month, but are still quite extensive. To date, the impacts have included:
- “A 36 percent decrease in opioid prescriptions, compared to 2016”
- “A 60 percent decrease in the number of patients ‘doctor shopping’ for opioid prescriptions, compared to July 2017”
- “A 58 percent increase in overdoses referred to behavioral health providers, compared to July 2017”
- “A 296 percent increase in naloxone doses dispensed by pharmacies, compared to September 2017”
Still to be implemented is a requirement that electronic prescriptions be used, an effort to cut down on fraud and forgeries. High population counties such as Maricopa (where Phoenix is) will implement the rule in January 2019, with the entire state following by July 2019. Also, starting in January, Arizona will regulate and license pain management clinics for the first time.
As Valdez notes, in Arizona (as in Dayton, Ohio), the measures demonstrate that government can effectively regulate business to protect consumers. But Valdez does not hide the fact that government helped create the crisis that city, county, and state public health departments are now working around the clock to mitigate.
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Earlier this year, Valdez notes, Dr. David Kessler, who was head of the US Food and Drug Administration (FDA) under President Bill Clinton in 1995 when OxyContin was approved, admitted the agency erred in approving the drug without testing. “No doubt it was a mistake. It was certainly one of the worst medical mistakes, a major mistake,” Kessler now says. But the errors didn’t stop with the hasty approval process that resulted in the sale and distribution of one of the deadliest drugs to receive FDA approval in agency history.
As NPQ has covered, Purdue Pharma, owned by the descendants of Mortimer and Raymond Sackler, heavily marketed OxyContin and is now facing hundreds of lawsuits from states, cities, and American Indian nations. But the feds were not neutral. Valdez recalls that, “The federal Centers for Medicare & Medicaid Services [was] including questions about pain management in patient satisfaction surveys that were used to determine hospital reimbursement rates.”
“The pressure was on to relieve pain, and opioids were sold as a safe way to do it,” Arizona Department of Health Services Director Dr. Cara Christ tells Valdez. Now, the government is “taking on chronic pain as a public health issue,” says Christ. Among other things, this means the state government is tracking drug usage and making available information and resources regarding strategies for managing chronic pain that extend beyond medication.
It is good to see that government actions are starting to make a meaningful difference. But is it too much to ask that the next time a drug is discovered to be dangerous, it won’t take 200,000 deaths nationwide to spur action?—Steve Dubb