Summary
This paper’s intention is to deliberate the United States Opioid epidemic that has been going on for quite an extensive amount of years. This paper will also discuss the suggested recommendations to put in place targeting Overtown, Florida. This paper will explain why Overtown, Florida needs the enhancement of the policy, along with various opportunities for growth and bettering of public health throughout South Florida. Opioids are oral medications that have been commonly misused even when prescribed for the reduction of physical pain. Addiction begins when someone becomes dependent and puts themselves at risk for a drug-induced overdose. In the year 2017, pharmaceutical companies began medical and prescription limitations on filling opioids. This limitation was made to ensure that only a week supply would be given out per person. In the year 2016, 63,632 drug-induced overdoses were recorded and 42,249 had been linked to opioids. (CDC, 2018).
President Donald Trump acted amongst these troubling and dark times. At this time, there became a stance on public health emergency. The following methods were concluded in efforts to aid the United States Opioid Epidemic: “reimburse State Medicaid programs to cover substance abuse and treatment facilities, expand funding and access to existing and new, integrated medication-assisted treatments, instruct doctors in proper practices in pain management, widely increase access to naloxone, finally, waive existing federal provisions inhibiting effective responses” (Hodge, Wetter, Noe 2017). The United States Opioid Epidemic helped millions of Americans reinvent the way most would look at treatment for substance abuse.
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Tackling the United States Opioid Epidemic is such an important topic to this day. Millions of Americans are losing control of their life and their life itself as the year 2019 comes to an end. The loss of millions of lives is rooted from scarcity in treatment options, lack of education on substance abuse, and pending support from the United States Government. The United States Opioid Epidemic is getting worse as time goes on because there is plenty of prosperity from political saying than losses. For example, the Needle Exchange Program gives out Narcan products to Americans. These organizations strong advocacy morals can be the line between life and death for millions of Americans. The United States Opioid Epidemic can better with the expansion and availability of Narcan, more public interest from schools and non-profit organizations, treatment centers accepting more insurance plans, social workers advocating for addicts, and an overall expansion on public education about the United States Opioid Epidemic.
Current Situation
The United States Opioid Epidemic is an ongoing battle that millions of Americans are still putting up their fights with. On June 1924, The Anti-Heroin Act was set forth as a Federal Law that banned the import and use of heroin and diamorphine. In 1970. The Controlled Substances Act of 1970 came to be. This Act was a federal policy that banned the import, making, use, and selling of stimulants, hallucinogens, narcotics, anabolic steroids, and depressants. In the year 2007, Perdue Pharma released a brand-new drug labeled as OxyContin. Perdue Pharma endorsed that when OxyContin was taken, the effects would be safer than that of Opioids. Perdue Pharma was eventually sued and charged with misleading the Americans for falsification of medical information. In the year 2010, the numbers of OxyContin use rose to 598,00. The most alarming fact of this dark statistic would be that the ages of users would range between twelve years old to forty-nine years old (Manchikanti, et al. 2012). In 2016, the United States Opioid Epidemic hit its boiling point. Roughly 64,000 Americans passed away from drug-induced overdoses. While in Florida, that same year, the consumption of heroin causing 952 fatalities, fentanyl causing 1,390 fatalities, oxycodone causing 723 fatalities, and hydrocodone causing 245 fatalities” (Florida Medical Examiners Commission Drug Report, 2016). In the year 2017, President Donald Trump authorized an executive order in correspondence to the United States Opioid Epidemic. President Donald Trump began the “President’s Commission on Combating Drug Addiction and Opioid Crisis. “The members of the Commission include Governor Chris Christie, Governor Charlie Baker, Governor Roy Cooper, Congressman Patrick Kennedy, Professor Bertha Madras, and Florida Attorney General Pam Bondi.” (House of Representative’s Final Bill Analysis, 2018).
On May 3, 2017, Governor Rick Scott signed the Executive Order 17-146 which focused on the United States Opioid Epidemic becoming a Florida Public Health Emergency. Executive Order 17-146 changed and renewed Florida first responders such as EMS and police to carry Narcan readily available on them. February 19, 2018, Florida’s Public Health Emergency was prolonged by Governor Rick Scott for sixty days. On October 26, 2017, President Donald Trump announced a nationwide public health emergency. Along with the announcement, President Donald Trump provided a five-point strategy to combat the opioid epidemic. The five-point strategy was stated as follows: access to prevention and treatment, targeting availability of Narcan, educating the public of the opioid crisis, provide support for research on addiction, and advance practice for pain management (NIH, 2017). On November 1, 2017, The President’s Commission on Combating Drug Addiction and Opioid Crisis made its final report and final recommendations. Their final report included: “reduce administrative burdens on funding towards the opioid epidemic, develop training for opioid prescribers, screening for mental health risk within patients, enhance the use of prescription drug programs and the way they monitor, and treat opioid addiction and recovery while researching” (NIH, 2017).
Proposed Changes
CS/CS/HB 21: “Controlled Substances” has been authorized to address the United States Opioid Epidemic. CS/CS/HB 21 sets forth health care practitioners must complete a board-approved, two hour continuing education course. All Florida Health Care Practitioners registered with the United States Drug Enforcement Agency must have completed the course by January 31, 2019. All Florida Health Care Practitioners must complete this mandated continuing education course when renewing their medical license (Controlled Substances Act of 2018). The continuing education course addresses the following: “up-to-date standards on prescribing controlled substances, alternatives to the current standards on controlled substance prescribing; and information on the risks of opioid addiction following all stages of treatment in the management of acute pain” (Controlled Substances Act of 2018). The course is mandated to be given by professional association of physicians that is legally accredited by the Florida Medical Association or the Florida Osteopathic Medical Association. The continuing education medical course can be completed in a long-distance format and must be included for the biennial renewal of a health care practitioner’s license. The Department of Health does not have the right to renew the individual’s license of a prescriber who fails to complete the mandated prerequisite (Controlled Substances Act of 2018).
CS/CS/HB 21 enacts the Department of Health to establish regulations and guidelines for prescriptions of controlled substances. These laws and regulations must contain the following: patient evaluation, creating and maintaining treatment plans, obtainment of patient consent and agreement, reviews conducted periodically, patient consultations, review of patient’s medical records, and medical compliance regarding controlled substances regulations (Controlled Substances Act of 2018). CS/CS/HB 21 limits the prescription amount of Schedule II opioids to a three-day period per patient. However, this amount may be modified to a week supply if a physician deems it medically necessary. If this is medically necessary, the documents and prescription bottle must indicate so prior to patient hand-off. Prescription limitations do not apply if the patient is treating cancer, terminal illness, or medical paint that may be associated with palliative care, or a severe injury with an Injury Severity Score of 9 or higher. If a physician prescribes a Schedule II opioid for a severe injury, CS/CS/HB 21 requires the physician to also prescribe an emergency opioid antagonist (Controlled Substances Act of 2018).
CS/CS/HB 21 began new regulations regarding medical reporting. By law, when opioids listed in Schedule II, III, and IV are given out, the controlled substances must be reported back to the Prescription Drug Monitoring Program (PDMP). CS/CS/HB 21 elaborates to include non-opioid controlled substances that is contained in Schedule V. CS/CS/HB 21 mandates the dispenser to document the following: patient’s phone number, indication whether the prescription is an initial dosage or a refill, amount of number of refills, name of person during hand-off, and government-issued Identification during hand-off (Controlled Substances Act of 2018).
CS/CS/HB 21 establishes regulations that pharmacies must follow during prescription hand-off. CS/CS/HB 21 requires patient consultations and a review of the PDMP to acquire patient history. This is mandated for patients sixteen years and older ages. The only case where a pharmacy does not need to report the hand-off is if there is a technical issue during hand-off. Although, the pharmacy must still report why the consultation of PDMP was not done and the prescription limit remains at a three-day dosage. Any pharmaceutical company that fails to comply is subject to a minor citation. However, offense occurs more than once, the dispenser will be subject to disciplinary action (Controlled Substances Act of 2018).
Effects of Proposed Changes
Continuing education courses for health care practitioners will help and educate not only those working in the field, but also current and future patients. By health care practitioner staying up-to-date on skills, medicine, and developments, they are more likely to be a valued worker to their company, as well as a confident worker for their patients to answer any minor or burning questions that they might have over medications. With the epidemic that has been going on for years, a patient might walk into pick up their prescription feeling very nervous during pick up. By having continuing education courses for pharmaceutical companies, breaking the ice and addressing medical concerns might be easier and smoother. Education starts by the curriculum of continuing education and flows between the confident dispenser and relieved patient. Lastly, continuing education will also provide ethical frameworks, instill a sense of accountability, and establish moral behaviors and decision -making.
Political Implications
CS/CS/HB 21 was put forth by Health Services Committee, Health Quality Subcommittee and Representative Boyd. CS/CS/HB 21 was a very successful proposition from the get-go as The Health Quality Subcommittee voted 15 YEAS and 0 NAYS, the House of Representatives voted 99 YEAS and 0 NAYS, and finally, the Senate voted 37 YEAS and 0 NAYS. On March 8, 2018, Governor Rick Scott signed for CS/CS/HB 21 and became effective on July 1, 2018. CS/CS/HB 21 many medical teams such as dentists, podiatrists, optometrists, physicians, physician assistants, pharmacists, and pharmacy technicians (Controlled Substances Act of 2018).
Pharmacies, medical providers, and physicians do not benefit from CS/CS/HB 21. As previously mentioned, pharmaceutical companies are notoriously infamous for honoring and marketing their products, even if their products do not benefit human lives. In the years 2000 and 2003, the FDA indicated that OxyContin labels contained misinformation, therefore misleading millions of Americans (FDA, 2018). Pharmacies and medical providers also do not benefit from CS/CS/HB 21 because having to complete a two-hour training course towards their licensure renewal puts more work to the staff members’ training and educational process. Physicians do not benefit from CS/CS/HB 21 because the legal penalty for overprescribing opioids rose in the year from a third-degree felony to a second-degree felony. If a physician is caught overprescribing controlled substances, they may be subject to disciplinary action.
Police officers and law enforcement benefits from CS/CS/HB 21. By common word of mouth, law enforcement’s mission is stated as, “to serve and protect”. By interfering with opioid-related crimes, law enforcement puts a stop to trends from an individual level, to a group-level, to possibly a community level. By serving their communities, law enforcement saves thousands of lives not only statewide but nationwide as well. Law enforcement has the power to charge drug dealers in federal court. Sometimes these scandals become news-worthy. By spreading awareness that smuggling opioids is a serious crime, this could reduce the numbers of incidents and save potential lives by reminding the public to seek help if they or a loved one are at risk for substance abuse through drug-dealing or through personal use.
Fiscal Implications
There are no fiscal impacts on the State Government revenues. However, there are fiscal impacts on the costs. CS/CS/HB 21 assumes $27,035,532 in nonrecurring funds from the Federal Grants Trust Fund to the Department of Children and Families (DCF), in costs correlating to the second year of the State-Targeted Response of the Opioid Crisis Grant. The purposes of these costs are prevention and treatment to cease opioid related overdoses. Another cost would be $14,626,911 in recurring funds from the General Revenue Fund to DCF towards community-based services. These community-based services include outreach, treatment, and recovery specialties. Social services might also include: aftercare services, outpatient services, case management, medicated-assisted therapies such as Narcan. As mentioned previously, $5,000,000 in returning funds from the General Revenue Fund to DOH is also provided for the costs of emergency opioid antagonists for distribution to emergency responders. $6,000,000 in recurring funds is provided from the General Revenue Fund to the Office of State Court Administrator for medicated-assisted therapy for those at risk for becoming involved in drug-related crimes or are mandated by the court. $873,089 is provided in recurring funds and $117,700 is provided in nonrecurring funds from the General Revenue Fund to DOH for innovations to PDMP (House of Representatives’ Final Bill Analysis, 2018).
There are also fiscal impacts for pain management clinics and criminal justice systems. Pain Management Clinics DOH savings are associated with decreases in the unlicensed-activity examinations occurring throughout pain management clinics. Standard costs of examination are roughly $2,100. In the last biennium, the Department of Health studied six examinations, which led up to a cost of about $12,600. Administrative spending is associated with allotting the credentials of exemption, are below spending relating unlicensed activity examinations. This results in saving expenditures (House of Representatives’ Final Bill Analysis, 2018). The Criminal Justice System’s fiscal implications would be that CS/CS/HB 21 has a positive impact on prison beds since CS/CS/HB 21 enacted that opioid-related crimes rose from a third-degree felony to a second-degree felony (House of Representatives’ Final Bill Analysis, 2018).
Recommended Action
On July 1, 2018, the CS/CS/HB 21: Controlled Substances Statute took effect. I support the passing and enacting of CS/CS/HB 21. After some consideration, I concluded that what we need is more public education amongst Overtown, Florida. This would be possible through various social workers speaking at major social services facilities such as Camillus House, Banyan Health Systems, Kristi House, and Miami-Dade Public Schools. I believe Florida International University would have great pull to make these connections happen. For example, Professor Boren and other social work professors at Florida International University could invite graduate students to prepare portions of speeches alongside of them at townhall meetings or local speaking events held in Camillus House and Touching Miami with Love. Additionally, since Law Enforcement also cares about this topic, we could invite them to share their experiences and current polices that have been put into place. This could very well target Overtown for now, but if more communities and people of power care and become involved, we could turn these meetings of public education, into an Opioid Awareness Day for Miami-Dade County. Lastly, I would recommend a lot of broadcasting tools such as Florida International University email alerts, Camillus House email alerts, Instagram and Facebook alerts on social media pages created for the prevention and awareness of opioid usage. I believe that spreading more awareness of CS/CS/HB 21 and resources to stop the opioid epidemic should not be a one-day or a couple of months duration. This should be a complete advocacy topic that social workers, law enforcement, teachers, and even health care practitioners can speak up in order to create more awareness and decrease the numbers of those who have lost or are at risk for losing their lives due to lack of education and substance abuse addiction. In conclusion… Calling all Social Worker Professors at Florida International University, could you help me, and millions of Americans start a movement on public education? Overtown and many other vulnerable communities like Allapattah, Miami Gardens, Downtown, etc. could use Professionals like us that really care about our community. If you are interested, please follow me on LinkedIn and let us start a conversation on how we can make community change happen. Let’s work on making an official “Opioids Awareness Day” in 2020!
References
- CDC/NCHS, National Vital Statistics System, Mortality. CDC Wonder, Atlanta, GA: US Department of Health and Human Services, CDC; 2017. https://wonder.cdc.gov.
- Controlled Substances Act, Fla. Stat. § § 456.0301 (2018). Retrieved from https://www.flsenate.gov/Session/Bill/2018/21/?Tab=Analyses
- Florida Medical Examiners Commission Drug Report 2016. (2017). Florida Medical Examiners Commission Drug Report. Retrieved from https://www.fdle.state.fl.us/MEC/Publications-and-Forms/Documents/Drugs-in-Deceased-Persons/2016-Annual-Drug-Report.aspx
- Hodge, J. G., Wetter, S. A., & Noe, S.A. (2017). Emerging legal responses to curb the opioid epidemic. Journal of law, medicine & ethics, 45(3), 460-63. Retrieved from https://doi.org/10.1177/1073110517737557
- Manchikanti, L., Helm, 2. N., Fellows, B., Janata, J. W., Pampati, V., Grider, J. S., & Boswell, M. V. (2012, July). Opioid epidemic in the United States. Retrieved November 24, 2018, from https://www.ncbi.nlm.nih.gov/pubmed/22786464
- NIH (2017). Evidence on Strategies for Addressing the Opioid Epidemic. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK458653/.
- The Florida Senate. CS/CS/HB 21 — Controlled Substances Bill Summary; Retrieved from https://www.flsenate.gov/Committees/BillSummaries/2018/html/1799
- Timeline of selected FDA activities and significant events addressing opioid misuse and abuse. (2018). Retrieved from https://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm338566.htm
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