Wolf: Limit opioid prescriptions for minors
Sept. 27--Kids shouldn't be prescribed bottles full of addictive opioids, Gov. Tom Wolf said today, adding to his legislative to-do list ahead of a major speech Wednesday on the overdose epidemic.
Saying he doesn't want more cases in which a young person "throws their knee out in field hockey and becomes addicted to opioids," the governor swung behind legislation, introduced last week, that would bar prescribers from giving a minor more than a week's worth of the painkillers.
"We lost 3,500, almost, Pennsylvanians last year [to drug overdoses], and it looks like more than that will die this year," said Mr. Wolf, who has made the fight against opioids a central focus of his administration. "This is a plague, and we've got to stop it."
Also today, newly released data showed that the incidence of newborns with neonatal abstinence syndrome -- opioid dependence driven by exposure in the womb -- has increased nearly ten-fold in 15 years. Last year, 2,691 newborns in the state had substance-related conditions, of which 82 percent had neonatal abstinence syndrome.
"So these poor [newborns] are going to be incredibly expensive for us to care for, and it's a completely preventable problem," said Dr. David B. Nash, dean of the Jefferson College of Population Health, at Thomas Jefferson University in Philadelphia. "There's no telling today what the downstream implications and the social costs are."
On Wednesday, Mr. Wolf will address a joint session of the General Assembly, in hopes of signing, by year's end, around a half dozen measures aimed at curbing the opioid problem.
Some legislators have urged modest expectations, with just a few session days remaining in a year heavy with reelection responsibilities. Others, though, called for an exercise of willpower.
"I think if we have the will to do it, even though we only have another two weeks, I think we can absolutely get most of that, if not all of that, done," Rep. Gene DiGirolamo, R-Bensalem. "I think it's absolutely possible to get that done, and I think we should try."
Mr. Wolf said that for minors, "seven [days of opioids] I think would be an appropriate cap."
A bill poised for a possible Senate vote Wednesday would prohibit medical providers from prescribing more than a seven-day supply of any opioid to a minor, with a few exceptions. The bill, by Sen. Gene Yaw, R-Lycoming, would require that if more than a week's worth of opioids was needed, the prescriber would first assess whether the young person had a mental health or substance abuse disorder and discuss the risks with a parent or guardian. Prescribers who flaunted the rules would face discipline against their licenses.
Concern about the use of opioids for young people has been heightened since last year, when the Food and Drug Administration approved the long-term use of the potent opioid OxyContin for children as young as 11. The director of the state chapter of the American Academy of Pediatrics could not be reached Tuesday.
Gov. Wolf had previously outlined four priorities. He would like medical schools, as a condition of receiving state funding, to teach good painkiller prescribing practices. He wants to require that prescribers take refresher courses in the pros and cons of opioids every two years.
He'd like to compel doctors to check the new patient drug history database every time they prescribe a controlled substance. And he swung behind proposals to cap opioid prescribing by emergency doctors at one week's worth of pills, with a few exceptions.
The Pennsylvania Medical Society, which represents doctors, has helped to write prescribing guidelines, but has generally opposed legislation setting prescribing rules.
Mr. Wolf said he has "heard support ... from the medical profession, so I guess it's who you talk to.
"We just want to make sure that no one is doing anything to get a patient -- and I believe no one in the medical profession wants this to happen -- to feed a substance use disorder unnecessarily."
Mr. Wolf also wants to mandate opioid education in schools, require that insurers cover abuse-resistant formulations of painkillers and create of a system under which patients can formally declare that they don't want to be prescribed opioids.
Lawmakers have also floated many of their own proposals, from infusions of drug treatment money to surcharges on prescription narcotics sales.
By last year, 19.5 out of every 1,000 newborns in the state faced substance-related considerations, up from 5.6 per 1,000 in 2000, according to the Pennsylvania Health Care Cost Containment Council. The rate varied widely by county, with Allegheny County just above the state average, and Greene County at six times that level.
"These findings stress the alarming impact that substance use problems have on new mothers and babies in communities across the Commonwealth," said Joe Martin, the council's executive director, in a press release.
Low birth weight, respiratory distress and difficulty feeding were more than twice as likely in newborns with substance-related challenges. Prematurity was almost twice as likely.
Last year, the council found, neonatal hospitalizations related to substance use added almost 28,000 hospitals days and an estimated $20.3 million in costs.
A Pittsburgh Post-Gazette investigation published in May showed that the state lagged behind lagged behind many of its neighbors in efforts to monitor patient drug histories, teach doctors the dangers of opioids, promulgate guidelines for the use of painkillers and discipline physicians who prescribed them wantonly. The investigation found that over five years, 608 doctors were disciplined for narcotics prescribing practices in the states that include most of Appalachia -- but just 53 of those were in Pennsylvania.
Meanwhile, opioid prescribing in Pennsylvania trended only slightly downward, while cheap heroin and fentanyl drove fatal overdoses skyward. In 2010, 1,916 residents of the state died from overdoses, and since then that grim toll has risen relentlessly to 3,383 last year.
Wider distribution of the medicine naloxone, encouraged by Mr. Wolf's administration, has resulted in 1,502 "saves" in potentially fatal overdoses since November 2014.
Over the summer, the Board of Medicine approved opioid prescribing guidelines for several medical specialties. The state became the 49th in the nation to operate a prescription drug monitoring program, through which doctors must check a patient's medication history before adding a new controlled substance. The budget includes new funding for rehabilitation, including 45 Centers of Excellence meant to treat 10,000 people annually.
Harrisburg Bureau reporter Karen Langley: klangley@post-gazette.com or 717-787-2141 or on Twitter @karen_langley. Rich Lord: rlord@post-gazette.com or 412-263-1542.
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