An epidemic is sweeping the mainland United States.
Since 1999, the sale of prescription opioids has quadrupled around the country. So has the number of deaths from various types of opioids including heroin and prescription painkillers such as fentanyl.
While not struggling with the same level of opioid addiction plaguing some of the hardest-hit areas, Hawaii has its opioid hot spots. In 2013 and 2014, a total of 315 people in Hawaii lost their lives to opioid overdoses.
But it’s not too late for us to get out in front of this challenge and prevent it from becoming a statewide crisis.
Deaths from opioid overdoses have quadrupled since 1999 across the nation. Changes in Hawaii law and practices would help prevent opioid abuse from spreading as widely as it has in many mainland states.
Eric Norris via Flickr
As Civil Beat’s John Hill revealed in a recent two-part report on opioid addiction and treatment in Hawaii, we were once a leader in fighting opioids, developing a prescription drug monitoring program in 1943 to flag patients with opioid problems for care providers and pharmacists. But not enough has been done since then to keep up with the faster pace of society and information sharing.
The result is a current drug prescribing system in which “if someone goes on a binge, they can hit six places on Oahu in two days,” as Sen. Josh Green, a legislator and physician, told Hill.
Putting measures in place that would help us better fight the problem we already have and prevent it from getting worse requires more will than brainpower. Successful strategies implemented in other states are ours for the adaptation.
• Improvetheprescriptiondrugmonitoringprogram. Physicians who prescribe opioids are required to sign up to access the statewide prescription drug database, thanks to Green-sponsored legislation signed into law in 2015. But those doctors aren’t required to actually use the database, and many don’t.
A Hawaii Department of Health survey revealed that about half of all prescribers are unfamiliar with it. Among dentists, that lack of awareness is 70 percent, in the survey.
Most prescribers don’t want to be forced to use the database, but the number of those who do is said to be steadily rising. Experts interviewed by Hill said making use of the database mandatory — as 18 states have already done — is an essential ingredient to stemming the flow of opioids to addicts.
• Modernize the database itself. Many prescribers are wary of having to spend precious clinical hours dealing with a frustrating information system. But Department of Health officials are already improving the database and should do more, both to allay such concerns and make the database more effective.
One possibility referenced in Hill’s report employs the same technology popular in so many smart phone applications: push notifications. Alerting prescribers when an addict is “doctor shopping” for opioids is an enhancement that some think care providers would appreciate.
Other needed improvements speak to how the database is governed. Hawaii ought not to allow prescribers a week or more to enter prescription information, allowing addicts to game the system during the lag time.
And legislators should end Hawaii’s status as one of only three states that don’t allow their medical boards to use their databases to identify doctors who overprescribe. Stopping those problem physicians would make it more difficult for addicts to find their fix.
• Make it easier for physicians to prescribe Suboxone. Successfully treating opioid addicts often requires anti-addiction medication, and Suboxone has been shown to offer significant advantages over other drugs, such as methadone. It’s less likely to cause an overdose, and it doesn’t have to be administered in a clinic.
But Hawaii law is so ambiguous regarding Suboxone that the head of the Hawaii Narcotics Enforcement Division recently threatened to stop doctors from prescribing it, touching off a panic among health care professionals who treat addiction. Attorney General Doug Chin fortunately intervened with an opinion that doctors could continue to treat patients with the drug.
The federal Drug Enforcement Administration already requires eight hours of training and education before doctors can get a waiver allowing them to prescribe Suboxone. That ought to assure lawmakers that sufficient care is being taken with this drug so that they can eliminate the confusion over its legality.
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