Calling the state’s opioid epidemic a “growing challenge,” Gov. Asa Hutchinson on Wednesday (Sept. 6) announced the immediate creation of a statewide standard for the widespread use of naloxone, an FDA-approved nasal spray and capsule that state health officials say has saved 12 lives in the past year.
During the recent legislative session, Republican Sens. Cecile Bledsoe and Lance Eads of Rogers and Prairie Grove, and Rep. Justin Boyd, R-Fort Smith, sponsored Act 284 of 2017, which developed the state’s “Naloxone Standing Protocol.” The legislation opened the door for licensed pharmacists in Arkansas to order, dispense and administer naloxone without a prescription in the event of an opioid-related drug overdose. Boyd is a licensed pharmacist.
The new law, which became effective July 31, 2017, broadens the Arkansas Creates Naloxone Access Act of 2015, which allowed healthcare professionals by standing order to prescribe and dispense naloxone to law enforcement officials and other first responders in the event of a drug overdose. The new law could only take effect after a standing protocol was approved by the Arkansas State Board of Pharmacy and the Arkansas State Medical Board, which took place last month.
“We recognize this is broader than first responders,” Hutchinson said. “This is a dramatic change. It goes live (now). As of today, family members and others that are concerned about saving lives and opioid abuse can now go to a pharmacist and say, ‘We need help.’”
According to the National Alliance of State Pharmacy Associations, Arkansas is now among 21 states with a statewide standing order or protocol for dispensing naloxone. In 2016, Arkansas saw the number of opioid-related deaths rise from 287 to 335 in 2016, according to the latest CDC data.
HIGH OPIOID PRESCRIPTION RATES
The action comes less than a month after a newly released 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’s 2016 average of 121 per 100 people.
The new CDC data released July 26 also shows that several Arkansas counties had prescribing rates exceeding 130 per 100 people, double the national average. In Greene County, located in northeast Arkansas north of Jonesboro, 177.8 pills are dispensed per capita. Garland and Sebastian counties have the second and third-highest opioid prescription rate at 176 and 169 pills, respectively.
Some of that sobering data was brought to the attention of Arkansas policymakers nearly a month ago when Arkansas Health Department Director Nate Smith gave a presentation to the Joint Interim Committee on Public Health at the State Capitol. According to Smith’s report, “large amounts of opioids are being sold in Arkansas,” enough 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.
ARKANSAS NOW ‘PRESCRIBER OF RECORD’
In the press conference at the Governor’s Conference Room at the State Capitol, Hutchinson mentioned the CDC report as ADH’s Smith, Arkansas Surgeon General Dr. Greg Bledsoe, Arkansas State Board of Pharmacy (ASBP) Executive Director John Clay Kirtley and Kirk Lane, the state’s new “drug czar,” looked on.
Under the new standing protocol, Smith will now become the state’s “prescriber of record,” allowing any pharmacy in Arkansas to dispense naloxone.
“There is no doubt that putting naloxone in the hands of more Arkansans, including our first responders will save lives,” Smith said.
Hutchinson said Arkansas’ new naloxone protocol mirrors recommendations made by President Donald Trump’s Commission on Combatting Drug Addiction and the Opioid Crisis in an interim report in July. Hutchinson said he participated in several conference calls held by the commission, which was chaired by Gov. Chris Christie of New Jersey.
During a White House briefing in early August with U.S. Department of Health & Human Services Secretary Tom Price and members of the Opioid Crisis Commission, 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.
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.
“That why the (president’s) task force was convened and I participated as a governor on the calls with … Gov. Christie and others and made a number of recommendations,” he said.
Kirtley, whose organization represents about 800 pharmacies and more than 6,100 registered pharmacists across the state, called the expansion of access to pharmacies a necessary strategy to make inroads in solving the emerging healthcare crisis.
“This is a momentous day and a new … and well-prepared strategy on the opioid epidemic that we have been facing,” Kirtley said.
A TEMPORARY FIX
Kirtley said naloxone only works to temporarily prevent opioid drugs from binding to the brain. If a person uses narcotics in combination with other drugs, such as alcohol or benzodiazepines, the overdose will be more difficult to reverse. Once the drug becomes widely available in Arkansas, the state’s chief pharmacist said a 4 milligram dose of naloxone hydrochloride will cost from $70 to $100 at a local pharmacy, usually sold under the brand name “Narcan.”
“It will allow people to breathe during an overdose situation,” Kirtley explained to reporters. “It’s a temporary type fix, but it allows them to breathe and seek medical attention in that effort.”
In response to question from reporters, Gov. Hutchinson said he is not ready to call the opioid epidemic a national or state emergency, noting that the use and abuse of prescription painkillers like oxycodone, hydrocodone and fentanyl still rank second to illegal methamphetamines in Arkansas. Hutchinson also said he believes President Trump will consider all the legal and technical details before declaring the opioid epidemic a national emergency. He added there are many consequences down the road for Arkansas and the rest of the country stemming from the nation’s addiction to painkillers.
“We’ve seen this happen in other states and I wouldn’t say we are ahead of the curve in Arkansas at all, but I also know we are not as far behind as some states. (But) we want to get ahead of this, move dramatically forward in this and follow some of those (presidential) recommendations that were made.”