BILL NUMBER: S5150

SPONSOR: HARCKHAM
 
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
each year.

 
SUMMARY OF SPECIFIC PROVISIONS:

Section 1. Adds a new subdivision 44 to Section 3302 of the public
health law. Subdivision 44 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, which
              

defines an opioid antagonist as an FDA-approved drug that, when adminis-
tered, 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 7 to Section 3309 of the public health
law. Subdivision 7-a provides that every initial opioid analgesic
prescription per year shall be accompanied with a prescription for an
opioid antagonist if any of the following risk factors are present: a
history of substance use disorder; high does or cumulative prescriptions
that result in over fifty morphine milligram equivalents per day;
concurrent use of opioids and benzodiazepine or nonbenzodiazepine seda-
tive hypnotics.

Subdivision 7-b mandates that a prescriber who fails to prescribe a
prescription, as required by this subdivision, shall be referred to the
appropriate licensing board solely for the imposition of administrative
sanctions deemed appropriate by such board. This section shall not
create a private right of action against a prescriber.

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 recent NYC Department of Mental Health and Hygiene study supported a
co-prescribing mandate to increase the availability of opioid antag-
onists. 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: A.1531-A - Referred to Health.

 
FISCAL IMPLICATIONS:

None.

 
EFFECTIVE DATE:
This act shall take effect on the ninetieth day after it shall have
become a law. Effective immediately, the addition, amendment and/or
repeal of any rule or regulation necessary for the implementation of
this act on its effective date are authorized to be made and completed
by the commissioner of health on or before such effective date.

                                
 
BILL NUMBER: S5150A

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

 
PURPOSE:

To prescribe an opioid antagonist, a drug used to counter the effects of
opioid overdose, with a patient's first opioid analgesic prescription
each year.

 
SUMMARY OF PROVISIONS:

Section 1. Adds a new subdivision 7 to Section 3309 of the public health
law, which provides that the first opioid prescription to a particular
patient each year shall be accompanied with a prescription for an opioid
antagonist if any of the following risk factors are present: a history
of substance use disorder; high doses or cumulative prescriptions that
result in over fifty morphine milligram equivalents per day; concurrent
              

use of opioid and benzodiazepine or nonbenzodiazepine sedative hypnot-
ics.

Section 2. 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 recent NYC Department of Mental Health and Hygiene study supported a
co-prescribing mandate to increase the availability of opioid antag-
onists. This legislation, by increasing access to opioid antagonists,
may be able to save the lives of those at risk for opioid analgesic
overdoses.

 
LEGISLATIVE HISTORY:

2013-2014: A9365-Referred to Health
2015-2016: A661-Referred to Health
2017-2018: A1531-A- Referred to Health

 
FISCAL IMPLICATIONS:

None to the state.

 
EFFECTIVE DATE:
This act shall take effect on the one hundred eightieth day after it
shall have become a law. Effective immediately, the addition, amendment
and/or repeal of any rule or regulation necessary for the implementation
of this act on its effective date are authorized to be made and
completed by the commissioner of health on or before such effective
date.