BILL NUMBER: S2976A

SPONSOR: HARCKHAM
 
TITLE OF BILL:

An act to amend the mental hygiene law, in relation to providing
discharged patients with certain educational materials regarding
substance use disorders and  two doses of an opioid antagonist in a form
approved for take home use; to amend the correction law, in relation to
providing previously incarcerated individuals with certain educational
materials regarding substance use disorders and  two doses of an opioid
antagonist in a form approved for take home use upon discharge from
incarceration; and to amend the public health law, in relation to the
provision of opioid antagonists for take home use upon discharge from
the hospital

 
PURPOSE:

Relates to providing discharged patients with opioid overdose education
and opioid antagonist for take home use.

 
SUMMARY OF PROVISIONS:
              

Section 1 adds a new subdivision (o) to Section 32.40 of the mental
hygiene law, mandating that a patient about to be discharged or condi-
tionally released from an inpatient facility operated or licensed by the
Office of Alcoholism and Substance Abuse Services, and who has been
diagnosed with an opioid use disorder, shall provide such patient with
an opioid overdose education that conforms to the Department of Health
or federal Substance Abuse and Mental Health Services Administration
Guidelines for opioid education. This education must explain the causes
of an opioid overdose, instruct when and how to administer life saving
techniques, an opioid antagonist, and how to contact emergency medical
services. Such facility shall also provide the patient as they leave the
facility with two doses of an opioid antagonist and a prescription for
an opioid antagonist.

Section 2 amends the correction law by adding a new section 149-a in
relation to released inmates with an opioid use disorder. Upon discharge
of an inmate who has been diagnosed with an opioid use disorder from a
correctional facility, regardless of whether that inmate has received
treatment for that disorder, the department shall provide such inmate
with an opioid overdose education that conforms to the Department of
Health or federal Substance Abuse and Mental Health Services Adminis-
tration Guidelines for opioid education. This education must explain the
causes of an opioid overdose, instruct when and how to administer life
saving techniques, an opioid antagonist, and how to contact emergency
medical services. Such facility shall also provide the patient as they
leave the facility with two doses of an opioid antagonist and a
prescription for an opioid antagonist.

Section 3 amends the correction law by adding a new section 511 in
relation to released inmates with an opioid use disorder. Upon discharge
of an inmate who has been diagnosed with an opioid use disorder from a
correctional facility, regardless of whether that inmate has received
treatment for that disorder, the department shall provide such inmate
with an opioid overdose education that conforms to the Department of
Health or federal Substance Abuse and Mental Health Services Adminis-
tration Guidelines for opioid education. Such facility shall also
provide the patient as they leave the facility with two doses of an
opioid antagonist and a prescription for an opioid antagonist.

Section 4 amends Section 511 of the public health law by mandating that
upon commencement of treatment, admission, or discharge of an individual
with a documented substance abuse disorder, or who appears to have or be
at risk for a substance use disorder, including discharge from the emer-
gency department, a hospital shall provide the individual with two doses
of an opioid antagonist.

Section 5 contains the effective date.

 
JUSTIFICATION:

Between 2015 and 2016 the opioid overdose death rate in New York State
increased by 40%. As of March 2018, more than 115 people in the United
States die every day from overdosing on opioids, according to the CDC.
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 to those readily available when an overdose is happening.
In 2018, the United States Surgeon General issued the first national
advisory in over a decade, urging all Americans to carry naloxone.

The American College of Emergency Physicians recently reported that
"addiction researchers have demonstrated that overdose events are an
important indicator not only of future overdoses but also represent a
critical opportunity for overdose prevention and engagement in the
treatment; those who have overdosed on heroin are four to five times
more likely to suffer a subsequent overdose event, and are at higher
risk for death from opioid overdose_ since 2004, drug-related emergency
department visits increased by over 80%."

A study titled "Peer Navigation and take-home naloxone for opioid over-
dose emergency department patients" found "a high frequency of death and
repeat overdose one-year following an emergency department visit for
opioid overdose." The Maryland Hospital Association recommended in
December, 2018 that "hospitals should offer naloxone to patients who
present in the emergency department with an opioid overdose and to
patients deemed to be at risk for opioid use disorder, by dispensing
directly from the emergency department or by providing a prescription."

According to the Harm Reduction Coalition, "individuals with a history
of drug use who are leaving jail or prison have a great likelihood of
overdosing in the first two weeks following discharge." A North Carolina
study published in 2018 by the American Journal of Public Health indi-
cated that "in the first two weeks after being released from prison,
former inmates were 40 times more likely to die of an opioid overdose
than someone in the general population. When restricted to heroin over-
doses only, the overdose death rate increased to 74 times the norm with
two weeks after release. Even the entire year after release, overdose
death rates remained 1018 times higher among formerly incarcerated indi-
viduals."

A report in the Journal of Addictive Diseases concluded that "due to the
increased risk of overdose following periods of abstinence_ pre-release
program of overdose prevention education, including Naloxone
prescription, of inmates with a history of opiate addiction would likely
prevent many overdose deaths." The study found that many will refuse to
call 911 in the event of an overdose, due to fear of police involvement.

In light of these tragic statistics, this bill mandates that inmates, as
well as patients about to be discharged from inpatient drug rehabili-
tation facilities, who have been diagnosed with an opioid use disorder,
receive opioid overdose education, as well as two doses of an opioid
antagonist and a prescription for an opioid antagonist.  Additionally,
upon commencement of treatment, admission, or discharge of an individual
with a documented substance abuse disorder, including discharge from the
emergency department, a hospital shall provide the patient with two
doses of an opioid antagonist.

 
LEGISLATIVE HISTORY:

2019-20: S6650 Passed Senate; A8541 (Braunstein) referred to alcoholism
and drug abuse

 
FISCAL IMPLICATION:

To be determined.

 
EFFECTIVE DATE:
This act shall take effect on the one hundred eightieth day after it
shall become law.