Board wants Narcan to fight opioid overdoses

A map provided by the National Prescription Audit shows opioid prescriptions per state (courtesy)
Staff Writer

By this summer, Mississippi residents concerned about a friend or loved one overdosing on an opiate may be able to get Narcan, which can reverse the effects of an opioid overdose, to keep at home or elsewhere.

That is one of several proposals the state's Board of Medical Licensure has on the table to combat the state's opioid addiction epidemic. And while several of the options may get bogged down in legislative review, the president of the Licensing Board is confident the Narcan idea will go through.

"It's like having an EpiPen around for allergic reactions. What we envision is allowing people to go to the pharmacy and get Narcan, I think for $40 you get two doses. They'll show you how to administer it and tell you what to do. You'll still have to call 911, but it may save someone's life," explained Dr. Bill Miles, a retired West Point obstetrician who is president of the licensing board and is serving as interim director.

San Francisco, Calif. just announced a controversial plan where drug addicts can come to health clinics and shoot up heroin and other drugs under the watchful eye of health professionals rather than overdosing in an alley or abandoned building. While Miles and other medical professionals aren't ready to take such a dramatic step in Mississippi, the Narcan proposal can save lives, they say.

"We had more than 200 overdose deaths in Mississippi last year, that's the ones we know of. And we had many more close calls. Nationwide, 175 people a week die of opioid overdoses. That's a 747 airplane crashing each week. If your wife or friend or whoever is addicted and you are worried, it's one more tool. It makes sense to put things in the hands of the public that can save a life," said Miles.

"I think we'll have it in place by the end of the summer," he added.

Meanwhile, tougher regulations and prescription guidelines for doctors are close to being formalized, although legislative and administrative oversight could slow the process.

The main prescription-writing proposals run along three categories of pain -- acute pain following surgery, chronic pain such as that associated with cancer, and chronic pain related to other issues such as back problems.

Limits on the length of prescriptions are proposed for each category. In addition, doctors must use the Prescription Monitoring Program database to make sure patients aren't seeing multiple doctors and pharmacies for the same problem, and long-term prescriptions must be accompanied by at least three urine drug tests a year.

The regulations aren't unlike other regulations and recommendations in the works. The Centers for Medicare and Medicaid Services is recommending a variety of changes for how opioids are administered, including a seven-day limit on prescriptions.

"Prescribers aren't the major problem, but we are a part of it. We have to acknowledge that we are. Just about every opioid addict got started with a legal prescription," Miles stated, citing studies that found that for every week a person takes an opioid beyond 20 days, they are 40 percent more likely to become addicted. 

The Licensing Board already has had one open hearing on the proposals and likely will have another in March before finalizing the regulations and guidelines.

But then a state administrative oversight committee must sign off. And two different pieces of legislation making their way through the Legislature could further slow, if not kill, the process.

One, which already has cleared the Senate, would establish another legislative review committee.

"That could grind everything to a halt," Miles lamented.

Another bill, which has cleared the House, would allow hospice directors to write prescriptions for opiates without every seeing the patient.

That is raising red flags on a number of fronts. Among other things, some have suggested hospice care already has some problems, considering that 17.9 percent of people placed in hospice care in the state survive beyond the 18-month hospice period. While Mississippi's rate is down from 23 percent, it's still well above the national average of 11 percent.

"I had a doctor who called me and said he had a problem. He had a patient in his office who had 'graduated' from hospice and needed his oxycontin and fentanyl," Miles said.

"We want hospice directors to be able to take care of their patients, because they provide a valuable service. But we want them to have to see the patient, even if it's by teleconference or something, to make sure of their condition and their needs," Miles continued.

Furthermore, some state lawmakers want the medical community to wait until the state can build and finance more health and treatment centers for addicts. But Miles and others wonder when or how that will ever happen, given the Legislature has been cutting funding for the state Health Department and hasn't had enough treatment beds for years.

"I don't know that waiting is an option. We are concerned. All we are trying to do is make sure the doctors, the vast majority who are doing the right thing, continue to think for a minute every time they pick up their pen to write a prescription," explained Miles.

Some critics of the proposed rules say shorter prescription periods, increased doctor visits and drug tests will be inconvenient for patients and drive up costs when health care expenses already are too high.

"We aren't saying the severe flu season is an inconvenience. If we had a typhoid epidemic and had to do more tests, we wouldn't say that is inconvenient. Unfortunately, we are having to write rules for 2 percent who are the problem. The other 98 percent don't even know who is on the licensing board," Miles stated.

"But there has to be some accountability, there has to be. This literally is killing us," he said, noting the current situation is driving up health care costs.

As for the extra drug tests, Miles said the tests are less than $10 and easy to administer in the office. He said charges should be no more than $30.

"These point of service tests are pretty simple. You just shake the specimen and look at it and you know the results. I someone is charging you more than $25 or $30, I'd ask why it's so expensive," Miles said of the proposed regulations.

"And once you start doing them, I think you'll be surprised at the things you'll find and how much you actually won't have to do them after awhile," he said.

Other doctors say some of this is a first step to getting a handle on another problem,  what some say is the over-prescribing of benzodiazapines; 1,317,976 prescriptions were written in the state last year. Those drugs in combination with opiates can be deadly.

"Hopefully this will get us talking about lots of things, to get doctors to look at other alternatives to things like Xanax. Some people with severe anxiety and panic attacks need them but I don't think it's anywhere near the 250,000 people taking it in the state," said one Golden triangle doctor who said he didn't want to wade into the debate publicly.

Furthermore, a growing number of doctors already drug test patients taking Adderall and other amphetamines to make sure they are taking them properly.

While the rules continue to make their way through the system, doctors are trying to get dentists, who have their own licensing board, to adopt similar rules. Dentists don't prescribe oxycontin as often but do prescribe Lortab, Percocet and other powerful painkillers.

"We hope they (dentists) will do something as well. We all have to be part of the process," he said, noting the biggest source of abuse referrals about doctors comes from pharmacists with nurses second and the Mississippi Bureau of Narcotics third.

"All we're trying to do is prompt a conversation between doctors and patients and families and everyone involved. That's the goal of all this," Miles concluded.