BILL NUMBER: S5868A

SPONSOR: RANZENHOFER
 
TITLE OF BILL:  An act to amend the public health law, in relation to
prescribing an opioid antagonist with a patient's first opioid analgesic
prescription in a given year

 
PURPOSE OR GENERAL IDEA OF BILL:

To prescribe an opioid antagonist, a drug used to counter the effects of
opioid overdose, with a patient's first opioid analgesic prescription,
which is equal to or greater than 50 morphine milligram equivalents, in
a given year.

 
SUMMARY OF SPECIFIC PROVISIONS:

Section 1. Adds a new subdivision 42 to Section 3302 of the Public
Health Law. Subdivision 42 defines "opioid analgesics" as the medicines
buprenorphine, butorphanol, codeine, hydrocodone, hydromorphone, levor-
phanol, meperidine, methadone, morphine, nalbuphine, oxycodone, oxymor-
phone, pentazocine, propoxyphene, as well as their brand names, isomers
              

and combinations. This section also adds a new subdivision 45 to Section
3302 of the Public Health Law, which defines an opioid antagonist as an
FDA-approved drug that, when administered, negates or neutralizes in
whole or in part the pharmacological effects of an opioid in the body.
The opioid antagonist is limited to naloxone or other medications
approved by the department for this purpose.

Section 2. Adds a new subdivision 5 to Section 3309 of the Public Health
Law. Subdivision 5 provides that every first opioid analgesic
prescription of the year, which is equal to or greater than 50 morphine
milligram equivalents, shall be accompanied with a prescription for an
opioid antagonist.

Section 3. Contains the effective date.

 
JUSTIFICATION:

Drug poisoning is the leading cause of death from injuries in the United
States. In New York State and New York City, between 1999 and 2008 the
leading cause of accidental death was overdose, ahead of accidental
falls and motor vehicle accidents. The vast majority of these overdose
deaths occurred inside the home.

According to studies by the Centers for Disease Control and Prevention,
drug poisoning deaths involving opioid analgesics, also known as
prescription pain relievers, such as codeine and oxycodone, have more
than tripled nationally since 1999, and between 2000 and 2011, the rate
of drug poisoning deaths involving opioid analgesics in NYC increased by
267%. In 2012, prescription opioid analgesics were involved in 28% of
overdose deaths in NYC. Between 2015 and 2016 the opioid overdose death
rate in New York State increased by 40%.  Additionally, eighty percent
of heroin users have reported that they used opioid analgesics before
switching to heroin. As of March 2018, more than 115 people in the
United States die every day from overdosing on opioids, according to the
CDC.

The CDC has stated that higher dosages of opioids are associated with
higher risks of overdosing. Furthermore, higher dosages have not been
shown to reduce pain over the long term. The CDC maintains the threshold
of "higher dosages" begins at 50 morphine milligram equivalents (MME)
per day, instructing clinicians to treat the prescription of 50 MME or
more as a risk factor for overdose. Dosages of 50 MME at least double
the risk of overdose from the risk at less than 20 MME.

Opioid antagonists, such as naloxone, are drugs that reverse the effects
of opioids, and are effective in preventing overdose deaths.  The avail-
ability of an opioid antagonist is crucial in ensuring that overdose
deaths do not occur. However, an opioid antagonist can only be effective
as an antidote if it is readily accessible when an overdose is happen-
ing. Additionally, opioid antagonists are non-habit forming and non-tox-
ic. On April 5th, 2018, the United States Surgeon General issued the
first national advisory in over a decade, urging all Americans to carry
naloxone.

Currently, opioid antagonists can only be used if they are prescribed.
A co-prescribing mandate would expand access to these life-saving drugs
by requiring that for the first prescription for an opioid analgesic,
which is equal to or greater than 50 morphine milligram equivalents, in
each year, the provider would also be required to prescribe an opioid
antagonist. A recent NYC Department of Mental Health and Hygiene study
supported a co-prescribing mandate to increase the availability of
opioid antagonists. This legislation, by increasing access to opioid
antagonists, may be able to save the lives of those at risk for opioid
analgesic overdoses.

 
PRIOR LEGISLATIVE HISTORY:

2013-2014: A.9365 - Referred to Health.
2015-2016: A.661 - Referred to Health.
2017-2018: S.5868/A.1531 - HEALTH/Health

 
FISCAL IMPLICATIONS:

None.

 
EFFECTIVE DATE:
This act shall take effect on the ninetieth day after it shall have
become a law; provided, however, that effective immediately, the addi-
tion, amendment and/or repeal of any rule or regulation necessary for
the implementation of this at on its effective date is authorized to be
made and completed by the commissioner of health on or before such
effective date.