News and Insights
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Top 3 Things to Know About Responses to the Opioid Epidemic
Arizona’s Declaration of a Public Health Emergency ended on May 29, 2018, but the Arizona Opioid Epidemic Act is still in full effect.
Arizona issued its “Opioid Overdose Epidemic Declaration of Emergency” on June 5, 2017. The Emergency lasted for just under a year until May 29, 2018. Seven months into the Emergency, the Arizona legislature passed the Arizona Opioid Epidemic Act (SB 1001) (the “Act”) on January 25, 2018. Several provisions of the Act apply directly to healthcare workers who prescribe, dispense, or administer opioids:
- Opioids must be prescribed electronically;
- Pharmacists must check the Controlled Substances Prescription Monitoring Program before dispensing an opioid or a benzodiazepine (Ariz. Rev. Stat. § 36-2606);
- At least one form of Medication Assisted Treatment must be available without prior authorization from a patient’s insurance company;
- Hospitals and emergency departments must refer patients to overdose treatment programs; and
- An opioid naïve patient’s first opioid prescription must be limited to five days, and dosage levels must be limited according to federal prescribing guidelines.
There are exceptions to the 5-day opioid prescription limitation, particularly for patients with chronic pain, cancer, trauma, burns, hospice or end-of-life patients, and patients receiving Medication Assisted Treatment for substance use disorder.
Arizona Department of Health Services Director Cara Christ, M.D. signed a standing order to allow pharmacists to dispense naloxone to any person in the state without a prescription. In addition, the Act also included a Good Samaritan provision to protect persons who call for emergency services for a potential opioid overdose from being prosecuted for other drug violations. Access to Naloxone has also been expanded to law enforcement.
Doctors are being prosecuted for prescribing decisions.
Although most of the litigation regarding the opioid epidemic generally concerns drug manufacturers and pharmaceutical companies, physicians are increasingly being held responsible for overprescribing opioids, especially where overprescribing leads to a patient’s death. For example:
- A Virginia physician was recently convicted of 861 federal drug charges and sentenced to 40 years in prison for over-prescribing opioids over the course of two years.
- A Virginia dentist was recently sentenced to 8 years in prison for “running a scheme to prescribe opioids for himself, fellow doctors and other individuals who didn’t medically need them.”
- A Northern California physician was recently charged with second-degree murder for four patient deaths resulting from overprescribing opioids and narcotics.
- An Oklahoma physician and two of the physician’s employees were recently charged with conspiracy to distribute opioids, prescribing opioids to patients without a valid medical purpose. Prosecutors allege the physician prescribed opioids to patients who had no valid need for the medications. Three patients died, allegedly as a result of the physician’s over-prescribing.
Pennsylvania Judge Rules that Supervised Injection Facilities do not Violate the Controlled Substances Act
The Federal Controlled Substances Act (“CSA”) makes it unlawful for any person to “manage or control any place . . . and knowingly and intentionally . . . make available for use, with or without compensation, the place for the purpose of unlawfully . . . using a controlled substance.” U.S. District Judge Gerald McHugh recently held that facilities which provide safe havens for drug injection, overdose prevention, counseling, and treatment referral services do not violate the CSA.
These facilities, often called Supervised Injection Facilities (“SIFs”), have been operating internationally since the 1980s, and are associated with decreased drug overdoses and overdose deaths among patrons and surrounding communities. Clandestine SIFs exist in the United States, but many localities seek to openly operate SIFs. Judge McHugh found that Congress did not intend to criminalize harm-reduction strategies such as SIFs in enacting the CSA, which, strictly construed, mainly targets “crack-houses” and other spaces that enable and encourage the market for unlawful drug use. Although this single ruling will likely be appealed, it could eventually lead to opportunities for business ventures seeking to open SIFs in local communities.
*For more information about these topics, and for source material, please contact Chelsea Gulinson at Chelsea@MilliganLawless.com.