Pubdate: Wed, 18 May 2016
Source: Providence Journal, The (RI)
Copyright: 2016 The Providence Journal Company


Gov. Gina Raimondo has unveiled a smart, multipronged plan to attack
the drug-overdose deaths afflicting Rhode Island. Her comprehensive
approach leaves few aspects of this public health emergency
unaddressed and, if appropriate funding is forthcoming, should help to
slow what has become a devastating loss of lives.

The governor has proposed spending $4 million in the next fiscal year
to curb the misuse of opioids. A prime focus would be the use of
medication-assisted treatment to help wean users off more dangerous
drugs. Ms. Raimondo's "Strategic Action Plan" also calls for doubling
the number of certified peer-recovery specialists, who are trained to
intervene in a crisis and help steer drug users toward treatment.

Rhode Island's overdose death rate has been ranked seventh highest in
the nation, and the worst in New England. As Governor Raimondo noted,
in the past five years, overdose deaths have claimed 1,000 lives in
the Ocean State. In recent months, several overdose deaths have
involved fentanyl, a powerful synthetic drug being used by dealers to
stretch the heroin supply.

The governor's action plan is based on work by her Overdose Prevention
and Intervention Task Force, which was organized last year. It
embraces several steps aimed at prevention. These include developing
regulations that restrict opioid dosing to a particular period of time.

To ensure better detection of problem usage, all prescribers would be
required to participate in the Prescription Drug Monitoring Program.
Currently, according to the governor's office, about 15 percent of
Rhode Island prescribers are not enrolled in the program, which
permits prescriptions to be tracked electronically. Worse, fewer than
half of prescribers even use the system. The governor's plan aims for
100 percent enrollment, and includes measures to increase use of this
electronic database.

The plan also seeks to encourage use of alternative drugs or therapies
for managing pain.

It would make use of a regional partnership to reduce trafficking in
heroin and other illicit drugs. In Rhode Island, users dependent on
prescription painkillers have been turning to these substances in
soaring numbers, as prescribers have tightened up on opioids.

Another key component of the governor's plan is increasing the
availability of naloxone, also known as Narcan, which can halt the
effects of an overdose in progress. A central fund will be established
to maintain an adequate supply.

On the treatment front, the plan calls for training 420 health-care
providers in administering medications such as methadone and
buprenorphine to combat addiction. Along with training more peer
counselors, steps to boost recovery efforts include certifying a
network of recovery houses and developing a model recovery plan. A
public information campaign will seek to raise awareness while
encouraging people to get help.

All of these efforts are needed, and will have to be undertaken in
concert to begin making a difference. Bills before the General
Assembly dovetail with some elements of the governor's plan: a few
seek to improve how overdose patients are treated in hospital
emergency rooms.

Privacy laws continue to inhibit notification of family members when
an overdose patient turns up at an ER. Unfortunately, there is no easy
way around this problem. Convincing people to enter treatment is
probably the greatest challenge of this crisis, and emergency rooms
offer one of the best chances to intervene. Ensuring that peer
counselors are present could save lives.

Although the governor's plan is basically sound, some caveats are in
order. Those who put the final touches on prescribing guidelines must
make sure they do not unduly limit physicians' options, or make it too
difficult for those in severe pain to receive needed medication in a
timely fashion.

The governor's plan will not work miracles. But it should help reduce
the number of deaths that misuse of opioids has caused.
- ---
MAP posted-by: Jo-D