State Spotlight: OHIO

Dealing with the Opioid Misuse/Overdose Epidemic

By: Jody Lutz

Reading Time: 5 minutes

Date: 08/29/2018

Ohio led the nation in opioid overdose deaths in 2014, and deaths have continued to rise with increased use of heroin and illegal fentanyl - fentanyl-related deaths surged from 75 in 2012 to 1,155 in 2015.

In addition, in 2016, 4,329 people died in Ohio from opioid overdoses, according to federal data. However, prescription drugs have been directly responsible for a declining number of deaths in recent years.

The Journal of the American Pharmacist Association paints a clear picture of the epidemic in Ohio in their article, "Strategies and policies to address the opioid epidemic: A case study of Ohio." The article provides the following setting facts, "Ohio has the fifth highest rate of drug overdose deaths (24.6 deaths per 100,000) in the United States. Unintentional drug overdose has become the leading cause of injury-related death in Ohio. In 2015, there were 3050 overdose deaths in Ohio, and in 2014 there were an estimated 12,847 overdose events reversed by emergency medical services with Naloxone."

The article continues onto state, "Ohio, Governor John R. Kasich has put in place one of the nation's most aggressive and comprehensive approaches to address opioid use disorder and overdose deaths, including a strong focus on preventing the non-medical use of prescription drugs." Part of this effort includes Senate Bill 319, which passed in 2017. This legislation provided specific regulations for opioid prescriptions including:

  • Limiting the amount of opiate pills that can be dispensed from a single prescription to a 90-day supply and invalidates opiate prescriptions that are unused after 30 days.
  • Prescribers are required to provide the diagnosis or condition requiring the opioids when reporting through the state's controlled substances database, the Ohio Automated Rx Reporting System (OARRS). 

 

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Additional legislation in the bill includes:

  • Requires facilities that administer Suboxone, which is used to treat opioid addiction, to 30 or more individuals to be licensed by the state.
  • Allows for-profit methadone clinics to open and waives the requirement that providers be certified in Ohio for two years prior to becoming a methadone clinic.
  • Allows homeless shelters, halfway houses, schools, treatment centers and other facilities that regularly interact with high-risk individuals to keep naloxone on site.
  • Eliminates an exemption in state law that allowed doctors, veterinarians, dentists and other health care professionals working as sole proprietors to distribute controlled substances to patients without oversight of the Ohio Board of Pharmacy.
  • Provides civil immunity to first responders and other authorized to administer naloxone, which reverses opioid overdoses.

 

Initiatives such as Take Charge Ohio layout a comprehensive multi-step plan for physicians who prescribe controlled substances.

 

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The framework for prescribing includes:

  • Non-Opioid Therapies First
  • Avoid Long-Term and Co-Prescribing
  • Press Pause
  • Review the Treatment Plan
  • Ensure Patient Safety

The program emphasizes Ohio’s multi-pronged approach to fight drug abuse:

  • Cutting the Pill Supply
  • Preventing Drug Abuse Before It Starts
  • Providing Treatment and Recovery Support to Those in Need
  • Saving Lives Through Naloxone

The full prescribing guidelines can be found here.

Project DAWN (Deaths Avoided by Naloxone) is an Ohio Department of Health project aimed at preventing overdose deaths as well as a naloxone distribution program. Participants receive training on:

  • Recognizing the signs and symptoms of overdose
  • Distinguishing between different types of overdose
  • Performing rescue breathing
  • Calling emergency medical services
  • Administering intranasal Naloxone

 

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The Ohio Board of Pharmacy provides the following guidelines:

Effective August 31, 2017, the State of Ohio will have new rules for prescribing opioid analgesics for the treatment of acute pain. Please be advised, the limits in the rules DO NOT apply to the use of opioids for the treatment of chronic pain.

In general, the rules limit the prescribing of opioid analgesics for ACUTE pain, as follows:

  • No more than seven days of opioids can be prescribed for adults.
  • No more than five days of opioids can be prescribed for minors and only after the written consent of the parent or guardian is obtained in accordance with section 3719.061 of the Revised Code. A guidance document (that includes exemptions to the consent requirements) can be accessed here.
  • Health care providers may prescribe opioids in excess of the day supply limits only if they provide a specific reason in the patient’s medical record.
  • Except as provided for in the rules, the total morphine equivalent dose (MED) of a prescription for acute pain cannot exceed an average of 30 MED per day.
  • The new limits do not apply to opioids prescribed for cancer, palliative care, end-of-life/hospice care or medication-assisted treatment for addiction.
  • The rules apply to the first opioid analgesic prescription for the treatment of an episode of acute pain.
  • The rules do not apply to inpatient prescriptions as defined in rule 4729-17- 01 of the Administrative Code.

An Ohio Department of Health news release adds additional depth to the opioid epidemic campaign. “The continued increase in opioid-related deaths reaffirms that we still have much work to do, but Ohio is seeing important progress in reducing the number of prescription opioids available for abuse and prescription-related overdose deaths,” said Dr. Mark Hurst, medical director of the Ohio Department of Mental Health and Addiction Services and interim medical director of ODH. “This progress is significant because prescription opioid abuse is frequently a gateway to heroin and fentanyl use later on.” You can find the entire release here.

 

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