Arkansas at front line of U.S. opioid epidemic

As President Donald Trump considers to formally make the nation’s battle against the growing opioid epidemic a national emergency, Arkansas and other states are now faced with a conundrum of how to wage that fight in their own communities.

During a White House briefing in early August with U.S. Department of Health & Human Services Secretary Tom Price and the President’s Commission on Combating Drug Addiction and the Opioid Crisis, Trump announced his intent to make the opioid crisis a national priority, which would bring an influx of federal funds and public health aid to communities in all 50 states to fight the growing health care crisis locally.

“Nobody is safe from this epidemic that threatens young and old, rich and poor, urban and rural communities. … It is a problem the likes of which we have not seen,” Trump said Aug. 8.

Prior to that White House meeting, President Trump issued an executive order for the Commission on the Opioid Crisis to come up key recommendations to stem the growing health care crisis. Led by Gov. Chris Christie of New Jersey, the Commission in late July issued an interim report recommending several key actions, including a national emergency declaration.

“Our nation is in a crisis. Your Executive Order recognized that fact. The work of your Commission so far acknowledges the severity of this national problem,” Christie wrote in the 10-page interim report to Trump. “The first and most urgent recommendation of this Commission is direct and completely within your control. Declare a national emergency under either the Public Health Service Act or the Stafford Act. With approximately 142 Americans dying every day, America is enduring a death toll equal to September 11th every three weeks.”

Despite the recommendations of the Commission and recent speeches by Trump highlighting the seriousness of the rising number of deaths from the nation’s growing addiction to opioid painkillers, health care officials are waiting for the president to sign an executive order that will speed up federal funding and services. For example, one of the Commission’s recommendations would grant Medicaid waivers to all 50 states to apply to open opioid treatment centers to treat thousands of Americans.

Other recommendations would mandate medical education training in opioid prescribing to treat pain, enhance federal access to so-called Medication-Assisted Treatment (MAT) that reduces overdoses, and prioritize funding and manpower to help federal, state and local law enforcement officials to develop fentanyl detection devices and stem the flow of deadly synthetic opioids through the mail.

Another proposal includes a national protocol for dispensing naloxone, the fast-acting, FDA-approved nasal spray used to treat drug overdose. According to the Commission, a presidential standing order would require the prescribing of naloxone with all high-risk opioid prescriptions and equip all local law enforcement officials with the potent drug to save lives.

ARKANSAS ACTIONS
But faced with the reality that opioid abuse in Arkansas is already at the emergency level, state policymakers, healthcare and lawmaker enforcement officials are moving forward with a number of directives.

A recent report by the U.S. Centers for Disease Control and Prevention (CDC) shows all but nine of Arkansas’ 75 counties had overall opioid prescribing rates higher than the national average of 66.5 prescriptions per 100 people. As a state, Arkansas has an opioid prescription rate of 114.6 per 100, second only to Alabama 2016 average of 121 per 100 people.

In a recent Joint Interim Committee on Public Health at the State Capitol, Arkansas Health Department (ADH) Director Nate Smith gave a report to lawmakers that enough opioids are now being sold in Arkansas for every man, woman and child to take 80 pills each over the course of a year. Altogether, 235.9 million pills were sold across Arkansas in 2016, Smith said, citing the most up-to-date data from the CDC.

One of the key strategies to emerge in Arkansas to address the prescription opioid overdose epidemic is the Electronic Prescription Monitoring Program (PMP), the state-run electronic databases used to track the prescribing and dispensing of controlled prescription drugs to patients.

Between 2012 and 2016, the Substance Abuse and Mental Health Services Administration within the HHS funded pilot projects in nine states that promoted use of federal PDMPs by registered prescribers and dispensers to inform their clinical decisions and allow for intervention at the point of care. Although Arkansas was not one of the original HHS-funded pilot programs, the Arkansas General Assembly did pass legislation in 2011 authorizing the setup of state PMP’s that encourage practitioners to monitor the dispensing of opioids and prescription painkillers such as oxycodone, hydrocodone codeine and fentanyl.

Under the program, each time a controlled substance is handed out to an individual, the dispenser submits the information to the state’s central repository weekly, providing a Sunday through Saturday window into the misuse and abuse of prescription drugs. It also gives doctors and other medical practitioners, as well as law enforcement agents and other authorized individuals and agencies, access to prescription drug data to help ensure the legal use of controlled substances in health care.

In the recent legislative session, Republican lawmakers Sen. Jeremy Hutchinson of Little Rock and Rep. Kim Hammer of Benton updated the 2011 law, sponsoring Act 820 of 2017 that now mandates prescribers of opioids to enter information on controlled prescription drugs to patients into the state’s PMP database.

In 2013, Arkansas lawmakers followed up the PMP legislation with Act 1331, which prevents Arkansas patients from obtaining opioids and other addictive drugs through forgery, fraud and deceit to prevent doctor shopping. However, it was the 2015 session when lawmakers introduced at least a half dozen bills that addressed the emerging health crisis. The key legislation was the Arkansas Prescription Drug Abuse Act, which allows the Department of Health to develop algorithms to determine if a patient is being prescribed opioids within a 30-day period by more than three physicians. It also lets prescribers delegate access to the PMP database, sets up opioid prescribing guidelines for emergency departments, and provides immunity for good faith reporting of suspected drug diversion.

Other legislation in the 2015 session allowed wider access to the PMP database, including giving law enforcement investigators access to information to aid in criminal investigations. Other key bills gave healthcare professionals access to naloxone and immunity from administrating the drug that blocks opiate receptors, and created a legislative task force to make sure those caught up in the criminal justice system can get behavioral treatment for substance abuse disorders.

HIGH SCHOOL EDUCATION, FEDERAL HELP
Arkansas Attorney General Leslie Rutledge has announced a number of opioid-related initiatives that make use of preventative measures and law enforcement methods to fight the growing epidemic in local communities. In late July at the Arkansas Sheriffs’ Association annual meeting in Northwest Arkansas, Rutledge announced a no-cost, CDC-approved education curriculum to be offered to all Arkansas high school students to help them understand the dangers of prescription drug misuse and how to prevent abuse.

“Talking about the harmful impact of prescription drug abuse with children and teenagers can no longer be a goal. It has to be a reality,” Attorney General Rutledge said. “Arkansas ranks first in the nation for ages 12 to 17 in misuse of painkillers. Reversing this trend is a top priority of mine. Prescription for Life will be available to every high school student in Arkansas beginning this fall.”

On Aug. 17, U.S. Rep. Rick Crawford, R-Jonesboro, introduced a bipartisan bill that will help rural communities bolster their efforts to fight the opioid and addiction epidemic. Under the Addiction Recovery for Rural Communities Act, rural communities would be able to better leverage U.S. Department of Agriculture (USDA) Rural Development programs to combat opioid and heroin use.

“The cost of opioid addiction goes beyond the heartbreaking individual loss of life: there’s also law enforcement and health care costs that weigh on all of us,” Crawford said. “But in rural America, treatment can be hard to administer, and the same tactics that work in urban areas aren’t as effective in places like the 1st District. We want to do our part at the federal level to help the folks at home who are dealing with this problem day in and day out.”
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Editor’s note: This is the first of three stories on the opioid issue as it relates to Arkansas.