House Bill H318: Opioid Prescription and Treatment Opt Out Act.

Written by Seth Hurley, Ph.D.

October 28, 2019

Abstract

The Opioid Prescription and Treatment Opt Out Act allows individuals to voluntarily opt out of receiving opioid medications. The bill was drafted in response to over-prescription of opioids in North Carolina. Prescription opioid medications have an addiction potential and over-prescription of opioids has contributed to an ongoing nation-wide opioid epidemic with overdose deaths and opioid prescription rates in North Carolina higher than the national average [1]. Given the severity of opioid addiction, this bill appears to be well supported. However, current alternatives to opioid-based medications may not be capable of treating severe forms of chronic pain.

History

Over-prescriptions of opioids is a critical factor driving drug overdose deaths, which have contributed to a decrease in average life span in the United States [2]. Opioids have an addiction potential as they produce a powerful state of reward and suppress negative emotions [3]. Negative emotions such as despair have risen in the United States, making individuals more susceptible to becoming addicted to opioids [4]. A 2013 survey found that 4 out of 5 heroin users began their opioid use from prescription opioids [5]. Opioid prescriptions tripled between the late 1990s-2011 nationally, but since then have been on the decline [6]. However, opioid prescriptions in North Carolina have seen less of a decline compared to prescriptions nationwide [7]. In 2017 there were 1,953 opioid-related overdose deaths in North Carolina, with most deaths attributed to the use of the synthetic opioid fentanyl, a very powerful activator of opioid systems [8]. The opioid epidemic shows trends of declining, between 2017 and 2018 there was a 9% decrease in opioid overdose emergency department visits.

The Bill

House Bill 318, the Opioid Prescription and Treatment Opt Out Act, provides individuals to voluntarily opt out of receiving opioid medications. An opioid treatment opt out form will be made available through The Department of Health and Human Services website that, when completed, prevents individuals from receiving opioid medications. The form must be signed by the patient or a patient’s representative and an authorized practitioner or their designee. Failing to comply with the request to not receive opioid treatment provides ground for liability in a civil action lawsuit, disciplinary action, or both.

Who Supports the Opioid Prescription and Treatment Opt Out Act?

The primarily sponsors of House Bill 318 are Mary Belk (D, Mecklenburg County), Maryann Black (D, Durham County), Josh Dobson (R, Avery, McDowell, and Mitchell Counties), and Donna White (R, Johnston County). The bill has received moderate bipartisan support with 35 democrats and 10 republicans sponsoring the bill. Given the severity of the opioid overdose epidemic and the relatively high medical opioid prescription rates in North Carolina, support for the bill is justified.

Who Opposes the Opioid Prescription and Treatment Opt Out Act?

Currently we are unaware of publicly stated opposition to the bill from representatives. However, reducing opioid medications has received scrutiny on a national level. Quality of life can be severely diminished in some individuals suffering from severe chronic pain when opioid access is limited and restricting access to opioids increases the likelihood these individuals engage in suicide [9]. Further, alternative pain treatments are often more expensive than opioid medications and are rarely covered by insurance [10].

Works Cited

1. Hedegaard, H., Miniño, AM, Warner, M. Drug overdose deaths in the United States, 1999–2017, in NCHS Data Brief, National Center for Health Statistics. 2018: Hyattsville, MD.
2. Joszt, L. CDC Data: Life Expectancy Decreases as Deaths From Suicide, Drug Overdose Increase. Accessed: 10/04/2019. Available from: https://www.ajmc.com/focus-of-the-week/cdc-data-life-expectancy-decreases-as-deaths-from-suicide-drug-overdose-increase
3. Stein, D.J., et al., Opioids: From Physical Pain to the Pain of Social Isolation. CNS Spectrums, 2014. 12(9): p. 669-674.
4. Case, A. and A. Deaton, Mortality and Morbidity in the 21st Century. Brookings Papers on Economic Activity, 2017.
5. Kolodny, A., et al., The prescription opioid and heroin crisis: a public health approach to an epidemic of addiction. Annu Rev Public Health, 2015. 36: p. 559-74.
6. Hoots, B.E., et al., 2018 Annual Surveillance Report of Drug-Related Risks and Outcomes, Centers for Disease Control and Prevention. 2018.
7. North Carolina Opioid Summary, National Institute of Drug Abuse. Accessed: 10/14/2019. Available from: https://www.drugabuse.gov/node/pdf/21978/north-carolina-opioid-summary Accessed: 10/04/2019
8. North Carolina Department of Health and Human Services. Poisoning Data. Accessed: 10/27/2019. Available from: https://www.injuryfreenc.ncdhhs.gov/DataSurveillance/Poisoning.htm.
9. Szalavitz, M. When the Cure Is Worse Than the Disease. Accessed: 10/04/2019. Available from: https://www.nytimes.com/2019/02/09/opinion/sunday/pain-opioids.html
10. US: Fears of Prescribing Hurt Chronic Pain Patients: Moves to Reduce Opioid use Limit Treatment Options. Accessed: 10/04/2019. Available from: https://www.hrw.org/news/2018/12/18/us-fears-prescribing-hurt-chronic-pain-patients#.