News: CJ Exclusives

Senate committee sets Thursday vote for opioid prevention bill

Bill sets limits on how many doses a physician could prescribe and mandates electronic reporting of prescriptions

A jarring supply of opioids is flooding North Carolina.

Sen. Tom McInnis, R-Richmond, said if all of the opioid pills prescribed in the past 12 months were counted, “every man woman and child would have a bottle of 100 in their hand. This is an excessive amount of these very, very addictive chemicals that cause all kinds of problems” including preventable deaths.

McInnis cited the data during a presentation to the Senate Health Care Committee on Wednesday.

Legal opioids are a gateway to more addictive, more lethal street drugs such as heroin, and overprescribing must be stopped, McInnis said. People oftentimes move from the pills and turn to the streets to find illegal narcotics, including heroin, from which prescription opioids are based.

Debate on House Bill 243, titled Strengthen Opioid Misuse Prevention (STOP) Act, included wide-ranging topics from the family pet to pot, but was for information only. The committee will vote Thursday on the measure.

The House bill is similar to Senate Bill 175, which the committee heard in March on an information-only basis.

The debate comes amid the backdrop of nine prosecutors representing nine Tennessee counties filing suit this week against several pharmaceutical companies that manufacture opioids. The suit claims the companies are drug dealers who have been untruthful about the addictive quality of their products, causing widespread addictions in the state.

Several other states also have taken legal action against opioid manufacturers.

The intent of the STOP Act is to strengthen the prescribing relationships between physicians and others. It would set limits how many doses a doctor can prescribe, with exceptions for hospice and palliative care patients, and chronic and acute pain sufferers.

Every prescription would be entered into a statewide Controlled Substance Reporting System, linked to the state Health Information Exchange. All controlled substances would be prescribed electronically to reduce fraudulent use of the narcotics, and for better data collection and analysis.

Rep. Greg Murphy, R-Pitt, a primary sponsor of H.B. 243, told the committee opioids in and of themselves are not “bad entities.” They are needed to treat acute and chronic pain.

He said the opioid epidemic began in the early 1990s, when several institutions, including the National Institutes of Health, criticized medical providers and prescribers for not doing enough to relieve patients’ pain. Several lawsuits were filed, including one in North Carolina, against hospitals, doctors, and nurses for not treating pain adequately.

But the pendulum has swung too far the other way after pharmacies and drug companies created more potent, longer-lasting medications, and hospitals and nurses based part of patient satisfaction surveys on pain management.

Sen. Jeff Tarte, R-Mecklenburg, asked if alternatives as effective as opioids existed.

Murphy cited non-narcotic pain medications such as ketorolac, along with yoga and physical therapy for people with fibromyalgia and other illnesses.

“There’s also — which some people are adamantly against — medical marijuana. Medical marijuana in states where it’s prescribed has been shown to cut the opiate use by 25 percent,” Murphy said.

“People that have chronic pain are going to use whatever they can get to relieve that pain, so we as a body need to be open to look at all alternatives,” said Sen. Paul Lowe, D-Forsyth, a pastor. He told of presiding over the funeral of a 34-year-old woman he had baptized and whose high school graduation he attended. He attributed her death to opioid addiction.

In response, Sen. Jim Davis, R-Macon, a primary sponsor of Senate’s version of the STOP Act, said the legislation will be amended and improved over time as policymakers get more information.

Murphy said bill sponsors were “especially sensitive” to rural physicians on the electronic reporting system because of the high cost. Rural doctors and podiatrists received more time to comply with the law.

Steven Stelma, a New Bern veterinarian, said animal doctors are both prescribers and dispensers of the controlled substances, and are affected by the bill much more than regular physicians. He requested giving veterinarians more time to comply.

Stelma cited problems meeting the electronic reporting requirements because vets often don’t have access to software compatible with the mandate.

Animals also can’t tell vets how much pain they’re in, and typically aren’t kept at animal hospitals for long stays, he said.