Colorado Opioid Legislation

Colorado Opioid Legislation

Introduction

In the last two decades, the number of deaths from drug overdose has tippled in the United States. In 2015, 63% of drug overdose-related deaths in America involved prescription opioids, such as oxycodone and codeine (Colorado Health Institute, 2017). States have also witnessed an increase in drug dependence and abuse, coupled with overdose deaths. Colorado is one of these states. The misuse and abuse of prescription opioids in Colorado is the state’s significant public health concern. In 2017 alone, 560 Colorado residents died as a result of heroin and opiate overdoes. As a response, the state’s policymakers and legislators responded by creating a bipartisan opioid and substance interim study committee to develop legislation to address its opioid crisis.

Legislation

In November 2017, the bipartisan group of Colorado state legislators drafting a package of six opioid bills to address the state’s growing opioid crisis. Out of six of the proposed laws, only five were passed. The collection of bills addresses the opioid crisis from numerous angles, such as limiting pain drugs prescription rates, promoting behavioral health care and medication-assisted treatment, and revising how Medicaid and insurance address opioid medications. The legislation became Colorado’s most comprehensive response to the opioid epidemic and was passed in January 2018 (Colorado Health Institute, 2017).

Each of the five bills had unique provisions addressing the opioid crisis. Senate Bill 22 aimed at reducing opioid addiction rates by limiting access to prescription pills. The bill limits the prescription of opioids to seven days worth of medication, and further consultation is done to determine an additional one-week prescription. An exception would apply to cancer patients, post-surgery pain, and palliative care. Additionally, the bill mandates that all opioid prescriptions are electronically submitted to licensed pharmacies and require physicians to check in with the prescription drug monitoring program (PDMP) before refilling prescriptions (Colorado Medical Association, 2019).

The second legislation is Senate Bill 24, aimed at increasing access to health care. The bill seeks to increase the number of behavioral health care professionals through the provision of government-sponsored incentives such as scholarship programs for health care students and student loan repayment programs (Kropp et al., 2019). In exchange, these experts would commit to a multi-year duty serving rural and underserved communities in Colorado. Beneficiaries of the programs include clinical psychologists, clinical social workers, professional counselors, and all other health care professionals. Even though opioid overdose-related deaths are high in Colorado’s urban areas, underserved or rural communities exhibit higher death rates (Colorado Medical Association, 2019). Lack of efficient treatment options and health care providers is one contributing factor, and Senate Bill 24 addresses the issue head-on.

House Bill 1136 is the third bill passed to address Colorado’s opioid crisis. A barrier in the treatment of opioid addiction or dependence is Medicaid. By law, Medicaid cannot offer treatment to institutions with over sixteen beds. Through the encouragement of the federal government, Colorado adopted House Bill 1136 to waiver the law hindering Medicaid (Colorado Medical Association, 2019). The bill aims to address the gap in the availability of health care services to the first Colorado enrollees, whose majority are not eligible for the SUD treatment programs.

The fourth bill is House Bill 1007, and this bill will require Medicaid and insurance companies to provide treatment coverage without prior authorization. The bill removed the concept of prior authorization in the treatment of opioid dependency and addiction. Patients will have prompt access to opioid treatment to prevent further use while waiting for coverage approval. The bill also prohibits the need for a patient to try an opioid before covering non-opioid related prescriptions in a process known as step therapy.

The fifth and final bill of the legislation is Senate Bill 1003. The bill addresses measures aimed at reducing and preventing the misuse and abuse of opioids in the State of Colorado (Kropp et al., 2019). The act creates an opioid and other substance use disorder committee consisting of ten general assembly members. The members will collect, study and analyze statistics and data on the scope of opioid and substance use problems in the state and develop prevention, harm reduction, intervention, recovery, and treatment programs for residents of Colorado (Colorado Medical Association, 2019). The bill would also review the accessibility of medication-assisted treatment and prescriptions while examining federal government measures set to address substance misuse and abuse all over the country.

The only opioid bill of the opioid legislation package of Colorado that did not pass was the Senate Bill 40. Aimed at substance harm reduction through the establishment of safe injection programs, the Senate bill 40 would have allowed the Colorado government to develop facilities where opioid addicts would safely continue abusing their drugs of choice under medical supervision. The proposed bill was indefinitely postponed and is yet to take effect (Frank, 2017).

Legislation Strengths and Weaknesses

Pain and treatment of chronic pain is a significant public health problem in Colorado and the entire country. Policies addressing the issue in both state and national levels aim to resolve cases of disparate, ineffective, and insufficient paint treatment by addressing available treatments such as opioids that increasingly cause public harm.

The Colorado opioid legislation package has numerous strengths and some weaknesses. Some of the advantages include; The bill offers a comprehensive call for action through bio-psychological approaches through integrated interdisciplinary care based on scientific evidence (Frank, 2017). The legislation also uses a public health approach in the treatment and prevention of opioid addiction through social science, epidemiology, medical informatics, and clinical research. The bill engages both federal and state agency stakeholders, and it emphasizes a change in payment or coverage models, competencies, and team-based care. The bill also aligns its purpose with the Institute for Health-care Improvement goals of reduced per-ca pita health care costs, improving patient care and health of populations.

The Colorado opioid legislation package focuses on the reduction of opioid use in the treatment of chronic pain with little emphasis on pain at the end of life and prevention. Data from the Centers for Disease Control and Prevention revealed that the Colorado legislation failed to meet CDC prescription guidelines (Frank, 2017). Consequently, other states implemented opioid legislation with limited prescriptions dosage centered on morphine milligram equivalents while the Colorado legislation did not address it. Also, more and more Colorado and national health care experts are still calling for strict opioid prescription policies, a sign of the legislation’s failure.

Stakeholders

The State of Colorado has a broad range of impressive stakeholders. The Colorado Consortium for Prescription Drug Abuse and Prevention which boasts of 500 organizations and individuals is the top legislation stakeholder. Others include; the Colorado community, federal agencies, public health professionals, professional health care organizations, Colorado medical society and non-profit organizations (Kropp et al., 2019). The impact of the six package legislation on stakeholder include; defining the state’s response to the opioid crisis, creation of action-bound addiction prevention workshops, increased state data surveillance and the formulation of opioid accessibility polices.

The legislation has also mobilized stakeholders and created awareness of Colorado’s opioid crisis and allowed stakeholders to improve health care quality through advanced research funding. Furthermore, health care providers have been left with the hard responsibility of determining the need for an opioid prescription, leaving room for illegal prescription of opioids.

References

Colorado Health Institute. (2017, May 30). Miles Away From Help.Colorado Health Institute. https://www.coloradohealthinstitute.org/research/miles-away-help

Colorado Medical Association. (2019, January). Spotlight on Colorado Best Practices and Next Steps in the Opioid Epidemic. American Medical Association. https://www.end-opioid-epidemic.org/wp-content/uploads/2019/01/AMA-Paper-Spotlight-on-Colorado-January-2019_FOR-WEB.pdf

Frank, J. (2017, November 17). For Colorado’s opioid crisis, lawmakers endorse prescription limits and the possibility of safe-injection sites. The Denver Post. https://www.denverpost.com/2017/10/31/colorado-opioid-legislation/

Kropp, A. K., Nichols, S. D., Chung, D. Y., McCall, K. L., & Piper, B. J. (2019). Prescription Opioid Distribution After the Legalization of Recreational Marijuana in Colorado, 2007-2017. BioRxiv. https://doi.org/10.1101/702811