Public policy in practice

Thursday, March 01, 2018 12:00 PM

Panel on opioid legislation outlines evolution of policy response to epidemic

by Kate Alfano, CMS Communications Coordinator

The Public Policy Leadership Forum gave attendees the opportunity to hear directly from physician leaders and legislators on the mechanics of passing legislation. The first panel of the day, “Making a Difference: The Anatomy of 2018 Public Health Legislation Resulting from the Opioid Crisis,” took the audience through the evolution of public health legislation resulting from the opioid crisis.

State Representative Brittany Pettersen (D-Denver) shared her personal testimony for getting involved in the effort to find viable policy solutions to aid groups in addressing the opioid epidemic: She saw her mother struggle with addition to prescription painkillers, then heroin, then be unable to find treatment when she wanted out of the vicious cycle of addition. “My story is ultimately why I started to lead on this issue because I saw a problem in our system,” Pettersen said. “I watched tens of thousands of dollars being spent just to keep my mom alive and then the doctors saying ‘I’m very sorry, there’s nowhere for us to send her,’ knowing that she would come back, sometimes that day or week but definitely that month.”

Pettersen was finally able to get her mom into treatment by overcoming difficult barriers to care. “My mom has been sober for more than six months. I never thought I’d have her back,” she said. “It’s an example of what’s possible when we wrap these services around people who are struggling and desperate for help.”

State Senator Jack Tate (R-Centennial) gave an overview of two bills he’s sponsoring in the 2018 legislature on the topic. “How do you gently have the state intervene in the clinician-patient relationship? The state can have a pretty heavy hand, and telling doctors what to do when it comes to patient care is something we should take with a certain amount of patience and prudence,” Tate said.

Tate spoke of one of his bills that would place prescription limits on opioids and set rules for how prescriptions are initiated and refilled while also putting regimens in place to check for drug-seeking behavior from patients. “It’s a complicated bill, and I’d say there’s still not consensus. It takes a lot of work and time to get people to understand what the agenda is, what the problems have been, and it’s important to let people have a role in the process and be heard to create agreement with the initiative.”

Jan Kief, MD, detailed the history of her awareness of the prescription drug abuse issue during her term as CMS president, the governor’s commitment to reduce the problem in Colorado, and the recommendation and subsequent passage of CMS policy by the CMS Board of Directors that set this issue as a high priority and committed CMS to coordinate and work proactively with the governor on effective strategies to reduce prescription drug abuse. “CMS is a lean, mean machine – we have limited resources, but we respond when members identify something that needs to be raised to priority,” she said. ‘“Leaders listen’ was the key, and the board did the right thing.”

Robert Valuck, PhD, RPh, FNAP, chair of the governor’s Consortium for Prescription Drug Abuse Prevention, discussed the evolution of the consortium, now a collaboration of more than 400 stakeholders from state and federal agencies and task forces, nonprofit organizations, physician and patient advocacy groups, public health organizations, and other groups who volunteer their time on 10 working groups focused on the major levers of the issue.

As for the future of the consortium, the State of Colorado approved the creation of a center dedicated to substance abuse research and prevention at the University of Colorado Anschutz Medical Campus in May 2017. The new center received $1 million from the state and will be part of the CU Skaggs School of Pharmacy and Pharmaceutical Sciences. The center will provide additional resources to the consortium as it works along with its partners to coordinate and support Colorado’s response to the opioid epidemic.

CMS has been involved since the beginning of the consortium. “We accept that physicians are part of the problem,” Kief said. “We are going to own some of this, learn as much as we can and do our part to educate. The public trusts us and we need to clean out any outliers in our house. The CMS workers’ comp committee had already seen the problems with opioid abuse for years. They are a very capable committee of dedicated people. It was not a hard sell at all.”

Don Stader, MD, CMS liaison to the Opioid and Other Substance Use Disorders Interim Study Committee, got involved in this issue years ago through his work as an emergency room physician. “The ER is where bad policy shows its face. We’re the ones who see the opioid epidemic through overdose, complications of using these and other drugs, or deaths. I have spoken with countless families who told me they knew [their loved one’s death] would happen. It gives you a new perspective. For medical students who will have rich careers, whenever you see injustices, it’s imperative that physicians stand up and try to fix that injustice,” he said.

“Physicians have been reluctant to participate in politics to the detriment of our society and patients,” Stader added. “We have to be much more involved; we have to realize the power in getting involved and forming relationships with great legislators so if we need something we can get it. That’s a tremendously important part of your practice. You as physicians have such a powerful voice because you see truth on a daily basis and you can articulate exactly what your patients are going through.”