ANNAPOLIS — Gov. Larry Hogan wants to curb heroin and opioid abuse, long before addiction. One of three bills the Republican governor plans to introduce this General Assembly session is the Prescriber Limits Act, which would limit opioid prescriptions upon an initial consultation or treatment to a seven-day supply.
In a press conference Tuesday at Anne Arundel Medical Center, Hogan and Lt. Gov. Boyd Rutherford outlined their administration’s past and current efforts to address the ongoing heroin epidemic, which claimed an estimated 51 lives in Frederick County last year.
The Prescriber Limits Act comes as other states are considering similar legislation.
A U.S. Centers for Disease Control and Prevention guideline issued last year concluded that three days’ worth or less would be sufficient for most acute pain, and more than seven days’ worth of opioid pain medication would rarely be needed. Limiting initial prescriptions is critical because long-term opioid use often begins with treatment of acute pain, according to the CDC.
Connecticut, Maine, Massachusetts, New York and Rhode Island passed legislation that limits initial opioid prescriptions to seven days’ worth in 2016, according to a National Conference of State Legislatures database. Pennsylvania enacted a law that requires a limited seven-day supply in certain situations, including when prescriptions are written in emergency departments or for minors. In Arizona, an executive order from the governor implemented a seven-day prescription limit in certain situations. At least two other states — Indiana and New Jersey — have pending prescriber limit legislation, according to NCSL.
Exceptions to the limit proposed by Hogan would apply when the opioid is prescribed for the treatment of pain associated with a cancer diagnosis or a terminal illness, or to treat a substance-related disorder. The full text of his proposed bills was not available Tuesday. The bills are scheduled to be formally introduced in the General Assembly on Wednesday.
The bill will likely be reviewed by the House Health and Government Operations Committee. Delegate Karen Lewis Young, D-District 3A, is a member of the committee and tried to pass legislation last year that would have held so-called “pill mill” doctors liable and subject to civil fines if improper prescribing led to an overdose death. The bill faced backlash from some medical organizations and was voted down by the House Judiciary Committee.
Without having seen the full text of the bill, Lewis Young said that there is some appetite in Annapolis for rolling back opioid prescriptions, but maintaining proper access to medical care for people in pain is also very important.
“It’s the greatest challenge ... finding that balance,” Lewis Young said.
She will not reintroduce her legislation this year, and is instead focusing on improving access to treatment programs, including at the Maryland Sheriffs’ Youth Ranch in Frederick County.
The two remaining bills from Hogan focus on overdose prevention and a new form of criminal prosecution.
The Overdose Prevention Act would expand the analyses by county fatality review teams to include non-fatal overdose data in addition to the fatal overdose data they currently review. The goal is to allow the review teams to recommend overdose prevention strategies.
The bill would also expand access to naloxone prescriptions directly from a pharmacist without the current training requirements and extend immunity provisions to pharmacists. Additionally, the bill would allow the Department of Health and Mental Hygiene’s Office of Controlled Dangerous Substances Administration to more easily take action against the controlled dangerous substance registration of a prescriber or dispenser based on investigations of the federal Drug Enforcement Administration or a state professional licensing board.
The Distribution of Opioids Resulting in Death Act would create a new felony charge that would allow police and prosecutors to seek up to 30 years’ imprisonment against sellers of opioids or synthetic opioids when the drugs lead to death. The bill would target kingpins and contains protections for those who sell drugs to support their own addiction, according to the governor’s office.
Hogan also signed an executive order on Tuesday. That measure authorizes the state’s Inter-Agency Heroin and Opioid Coordinating Council to establish a statewide Opioid Operational Command Center. The center will bring together the work of federal, state and local organizations, with a focus on data collection to inform future policy decisions.