U.S. Senate bill takes aim at prescription drug abuse

In some of the neighborhoods with the highest reported drug use, Donnelly, D-Ind., said it didn’t take long to find victims of Austin’s drug epidemic, a target of legislation he co-authored to attack prescription opioid and heroin abuse on a multitude of levels.

“I could see people right there on the street who, it was clear they were struggling with addiction,” Donnelly said. “This was in the middle of the day, so this is as serious as it gets.”

His private tour was prompted in part by the worst HIV outbreak — with more than 165 confirmed with the AIDS-causing virus — the state has ever seen, tied to intravenous drug use of prescription opioids, Opana being Austin’s drug of choice.

The town has been crawling with media coverage since word of the HIV problem spread weeks ago. National television news stations have highlighted the epidemic and Austin made the cover of Time magazine, though for reasons it’d rather not have the publicity.

Donnelly tried once before to pass the Heroin and Prescription Opioid Abuse Prevention, Education, and Enforcement Act in 2014. It never made it out of committee, but this time around, Donnelly said he thinks it could emerge to help curb opioid abuse across the country.

“[The bill] has a little bit more understanding [than last time],” Donnelly said. “People are seeing that the problem is not getting better, it’s getting worse. We need to step up and intervene here.”

SECOND ACT

Donnelly’s legislation — co-authored with Sen. Kelly Ayotte, R-N.H. — sets up a framework for a few efforts to tackle opioid abuse. It aims to set up a task force to develop responsible prescribing practices of opioid pain medications, which would minimize the amount of unused or unneeded prescription drugs from patients making it to the streets. It includes federal government representatives, but also medical professionals, addiction experts and pain researchers.

The task force doesn’t have any rule-making authority, but would make recommendations on how to put policy forward.

Donnelly said that’s a big part of the drug problem nationwide. He said though some conditions don’t require a heavy regimen of painkillers, doctors sometimes go to a standard prescription that goes long after a patient is finished recovering from pain.

“What we’ve seen time after time is somebody who may have suffered an injury where they need five days of pain pills,” Donnelly said. “The default prescription is 30 days, so you have a massive amount of additional pills on the market that are on the illicit market. We need to eliminate that.”

State Rep. Ed Clere, R-New Albany, said that’s also been a concern for Indiana government, but he said fixing the issues will take collaboration between state, local and federal governments.

“Prescribing practices have been a focus throughout this effort over the last several years to reduce prescription drug abuse,” Clere said. “As to whether there’s a need for what Sen. Donnelly is proposing, we’ve made a lot of progress, but there’s still a major problem. I think his proposal has the potential to help as we continue to elevate the issue and the discussion.”

Also, Donnelly’s act sets up a drug monitoring program to reduce the abuse of prescription medications. The Harold Rogers Prescription Drug Monitoring Program would be funded at $9 million for each year from 2016 to 2020.

Clere said Indiana has a similar program on the books, INSPECT. It’s a database doctors can use to see if a patient has visited multiple doctors just to get pain medication, or doctor-shopping, and also see how much of what drug they’ve been prescribed. But that database comes with concerns, Clere said, as data breaches become more common.

“You might say that INSPECT’s greatest strength is also its greatest weakness,” Clere said. “In other words, it contains millions of patient records, which is an unparalleled tool for prescribers and law enforcement. But it also creates potential opportunity for anyone who might try to gain access to those records illegally and for unauthorized purposes.”

But one of the provisions in Donnelly’s bill calls for grant funding for prescription drug management programs like INSPECT, so some of that money could beef up the security of the database.

Along with all that, the bill sets up a media campaign similar to billboards seen outside of Scott County warning of a need for HIV testing, as well as grants to give police, fire, EMTs and other first responders demonstrations on naloxone, a drug used to counteract opioids in the instance of an overdose.

Donnelly said the current advertising campaign for HIV testing remains a huge piece of solving the issue and whatever follows from his bill could help.

“As you drive down I-65 as you get nearer to Scott County, you see billboards now, you see other things,” Donnelly said. “We want to make everyone aware of what’s going on, also so that it’s not a hidden secret that people are familiar with the fact that there’s a huge problem here, there’s a safety issue. Act accordingly and make sure that you protect yourself.”

TREATING THE AFFLICTED

With a needle-exchange program enacted in Austin to curb the spread of disease, Donnelly’s legislation lines out that HIV isn’t the only illness that needs treating — addiction needs attention, too.

Through a provision to reauthorize the Byrne Justice Assistance Grant Program — a federal grant set up to support law enforcement, drug treatment and other related initiatives — could help fund or start programs like the Clark County Drug Treatment Court.

Vicki Carmichael, Jeffersonville’s Circuit Court No. 4 judge, also administers Clark County’s Drug Court. She said since its inception about 15 years ago, the program has worked to rehabilitate addicts who want to get away from drugs. But that takes willing people in the program, she said.

“We always say that people have to want to stop using, they have to want to stop drinking themselves, you can’t force somebody to do that,” Carmichael said. “You can’t force them to want to change.”

But for the ones who want that change, Carmichael said there’s a lot of success at drug court. Few of them come back through the criminal justice system, but she said that doesn’t mean overall crime has gone down.

That’s where outside agencies fill in, she said. At Lifespring, a program called Project 180 is about to start, designed to bridge the gap between the criminal justice system and mental health or behavioral health agencies.

“These are the kinds of services that we need,” Carmichael said. “This gives more services to the defendant to know they’ll be assisted through case management, group and individual therapy and it’s all evidence-based. Lifespring got a grant to do that and hopefully, that will be a good resource for that.”

She said unless there are enough beds, treatment centers, mental health professionals and addiction counselors in any one geographic area, it’s hard to get people who are in the system to stay out of the system. If that grant money continues, she said it could go a long way to help those programs rehabilitate offenders.

“If Sen. Donnelly’s funding comes through, that’s absolutely what we need, more resources,” Carmichael said. “The one thing we lack is the number of beds for inpatient treatment, mental health and substance abuse counselors.”

ROAD TO THE VOTE

Donnelly said his Austin visit included meeting with high school students, talking to them about what’s going on in Austin and letting them know that people want to help their community, and communities elsewhere, as evidenced by Ayotte’s involvement.

“The fact that she’s from new Hampshire is a pretty good indicator to everybody that this is not just an Indiana problem,” Donnelly said. “We may have become the most notable case in Scott County, but [drug abuse] is eating our country up all across the nation.”

He said his bill isn’t meant to mandate one solution, but to give experts the flexibility to work out sound ideas on how to address prescription issues, drug abuse and the spread of disease.

Clere said there has to be a careful balancing act within that, though. Though there’s potential to help the problem of prescription abuse, there also has to be protection of patients who genuinely need pain medication, as well as doctors who think that kind of treatment is the best route for a given patient.

“It’s not just about over-prescribing,” Clere said. “Now, as we have tightened requirements on prescribers and patients, we need to make sure that those new requirements aren’t preventing people who really need pain medication from having access to that medication.”

Though the Heroin and Prescription Opioid Abuse Prevention, Education, and Enforcement Act of 2014 never got off the ground, he said the act of 2015 builds upon its predecessor and already has a lot of support behind it, including from State Health Commissioner Dr. Jerome Adams.

“I think first, we need to get this legislation passed as quickly as possible, that’s what we’re working on,” Donnelly said. “I think the general outlines would be great for the state to put in place right now as we work this through the federal system.”