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Opioid Abuse Prevention

As Wyoming tries to control supply of opioids, patient, prescriber complications emerge

in News/Health care
As Wyoming tries to control supply of opioids, patient, prescriber complications emerge

By Laura Hancock, Cowboy State Daily

Through decades of numerous, unpredictable illnesses, pain has become a constant for Cody resident Dawn Scott.

But with the opioid epidemic raging in Wyoming and throughout the U.S., obtaining painkillers has become as unpredictable as epithelioid hemangioendothelioma, the rare cancer she fought in the late 1990s. 

The guarantee of a doctor prescribing opioids can be as uncertain as her thoracic outlet syndrome, the illness that resulted in 21 surgeries between 2014 and 2016, which left her with most of her collarbone removed and muscles that had been attached to the clavicle reattached to other parts of her body. 

“Once I tell them the amount of opioids I’m going to need to get relief — which is significant after 21 years of surgeries — I’m almost instantly labeled a seeker,” she said. “Unless it’s an ER doctor who knows me and knows my history. Newer doctors or loaner doctors don’t offer any form of pain control.”

As state leaders try to control the flow of opioids in Wyoming, complications have emerged. Chronic pain patients have had trouble getting the medicine they need to be comfortable and live productive lives. Physicians and other prescribers – already under watch by private insurers and government health care programs – have new laws to consider in their practice. 

But state leaders, concerned about addiction and its effects on families and communities in Wyoming, felt it necessary to change the law and make it harder to dispense and obtain opioids.

Last month, the Cowboy State Daily reported more than 100 million painkillers were shipped to Wyoming pharmacies between 2006 and 2012. The state, local governments and Indian tribes have sued drug makers and distributors, saying they aggressively marketed the medicines and downplayed their addictive tendencies. 

In February, the Wyoming Legislature passed Senate File 46 and Senate File 47 – its own response to the opioid epidemic. 

S.F. 46 prohibits prescribing and dispensing more than a 7-day supply of opioids in a 7-day period to an acute pain patient, with the Wyoming State Board of Pharmacy to establish “reasonable exceptions” for chronic pain, cancer treatment, palliative care and other clinical exceptions.  The pharmacy board is working on rules

The 7-day law is similar to restrictions in about 15 other states

S.F. 47 requires licensed health care professionals to take continuing education courses in the responsible prescribing of controlled substances, which includes opioids. 

The law also requires prescribers to upload controlled substance prescriptions electronically to the Wyoming Online Prescription Database by Jan. 1, 2021, so that doctors, pharmacists and other professionals can review what drugs a patient is on — and prevent abuse or adverse side effects.

The federal government has touted state-level prescription drug monitoring programs as a way to spot and close down “pill mills,” and reduce addiction and overdose deaths. Wyoming physicians — who feel they don’t have a problem with over-prescribing, save for a few extreme examples – say the new state laws are heaping on more regulations on top of various insurance and government health care programs, said Sheila Bush, the Wyoming Medical Society’s executive director.

For instance, Medicare encourages physicians to check the prescription drug monitoring program when writing opioid scripts. One private insurer may prohibit opioids for patients under a certain age, another may limit patients to three days of opioids. There are federal laws, and now state laws, she said. 

“Separate from all of this, you still have good clinical knowledge – the ability for a physician to look at a patient and know the history and say, ‘This is the best care for you today,’” Bush said.  “They’re inundated. There’s no consistency.”

The Medical Society was supportive of the Wyoming legislation because it knew the public had asked for changes in the law. The organization felt that having a seat at the table and providing doctors’ expertise could make the measures better, she said. 

But Wyoming patients with serious medical issues may suffer as a result of these policies. 

Scott, the Cody chronic pain patient, had a miscarriage in a 2016. She asked the physician for painkillers for her cramping. She received just one pill – two milligrams of the opioid Dilaudid. 

“My normal dosage to give me maximum relief is between 12-16 milligrams of Dilaudid,” she said, describing the following days as agonizing. 

Scott has since found a pain specialist in Billings, Montana, who has reduced her trips to the emergency room when migraines, cluster headaches and other pain flares up. 

Scott, who as an attorney has represented people with chronic pain, believes opioids aren’t addictive for everyone. Some patients use them responsibly to relieve pain, she said. Scott said she’s gone through periods in which she didn’t have to take any painkillers. 

“It’s sad, and I’ve watched addiction first-hand, not with opioids – but my dad died of alcoholism,” she said. “I understand the power of addiction. I understand there needs to be control. But there also needs to be a case-by-case basis, not just a blanket decision that, ‘I’m not going to ever offer over 2 milligrams of Dilaudid.’ They feel like their discretion is being scrutinized because of regulations. Some doctors want to help people and they’re limited.”

More than 100 million prescription painkillers ended up in Wyoming in six years

in News/Health care
More than 100 million prescription painkillers ended up in Wyoming in six years

By Laura Hancock, Cowboy State Daily

Drug makers distributed nearly 126.7 million painkillers in Wyoming between 2006 to 2012, according to a federal prescription database recently made public.

That includes hydrocodone, which goes under the name brands of Vicodin and Lortab, and oxycodone, which goes under the name brand of OxyContin

The U.S. Drug Enforcement Administration database is being used in litigation by more than 2,000 entities such as state governments, local governments, tribes, labor unions and hospital systems – including several in Wyoming – in a federal courtroom in Cleveland. The litigation alleges drug manufacturers and distributors aggressively marketed the medicines, downplayed their addictive tendencies and created an opioid scourge that’s become a national epidemic. 

The Washington Post and the Charleston Gazette-Mail in West Virginia successfully fought to make the information public, and the Post created a searchable database — from which the Wyoming data was pulled.

The following describes prescription opioids sent to each Wyoming county between 2006 and 2012:

Albany4.5 million pills18 pills per person each year.
Big Horn3.7 million pills45 pills per person each year.
Campbell10.6 million pills35 pills per person each year.
Carbon3.1 million pills28 pills per person each year.
Converse2.9 million pills31 pills per person each year. 
Crook250,100 pills5 pills per person each year. 
Fremont7.8 million pills28 pills per person each year. 
Goshen2.2 million pills25 pills per person each year. 
Hot Springs1.8 million pills53 pills per person each year. 
Johnson1.2 million pills21 pills per person each year. 
Laramie20 million pills32 pills per person each year. 
Lincoln3.9 million pills32 pills per person each year. 
Natrona20.4 million pills39 pills per person each year. 
Niobrara421,800 pills25 pills per person each year. 
Park10.3 million pills53 pills per person each year. 
Platte2.2 million pills35 pills per person each year. 
Sheridan7.1 million pills35 pills per person each year. 
Sublette1.5 million pills23 pills per person each year. 
Sweetwater9 million pills30 pills per person each year. 
Teton3.3 million pills22 pills per person each year. 
Uinta5.8 million pills40 pills per person each year. 
Washakie3.1 million pills54 pills per person each year. 
Weston1.6 million pills32 pills per person each year. 

Several Wyoming governments are involved in separate litigation over opioids, including the state, Carbon County, Rock Springs, Green River, Casper, Cheyenne, and the Eastern Shoshone and Northern Arapaho tribes. Lawsuits have been filed in state and federal court

The plaintiffs in all of the lawsuits argue that drug treatment has cost them millions of dollars through Medicaid and community treatment facilities. Many people, hooked on prescription opioids, have turned to street drugs – including fentanyl-laced heroin. Some have overdosed and some have died— including nearly 50,000 across the U.S. in just 2017 alone

State Rep. Charles Pelkey, D-Laramie, said he was pleased to see the state taking action in the face of large distribution numbers.

“Much of the responsibility lies with the pharmaceutical companies who marketed aggressively, unaware or intentionally ignorant of the consequences,” he said in an email. “We can some things legislatively, but I am pleased to see that the state is pursuing the matter in the courts as well. If legislation doesn’t achieve the desired goal, maybe hitting them in the pocket, where it counts, will.”

Wyoming’s case is pending in district court in Laramie County, where OxyContin maker Perdue Pharma wants it dismissed. The state is opposing the motion.

Michael Pearlman, spokesman for Gov. Mark Gordon, said this week that the Wyoming Attorney General’s Office is waiting for the district court to rule on dismissal. 

“In the meantime, the court entered a scheduling order, including among other things, discovery deadlines which the AGs office is following,” he said in an email.

According to filings, the case is expected to continue at least through 2020.
The lawsuits filed by Wyoming cities and tribes are in federal court, all consolidated in U.S. District Judge Dan Polster’s Ohio courtroom. Bloomberg reported Tuesday that McKesson Corp., Cardinal Health and other drug distribution companies have offered a $10 billion settlement in lawsuits filed by the various states. A group representing some plaintiffs countered with $45 billion. 

Drug makers haven’t yet begun settlements with the plaintiffs in federal court in Ohio, but the judge is pushing for the parties to settle soon to end all the suits and help set aside money for drug treatment and prevention. Perdue Pharma separately settled with Oklahoma for $270 million.

Pearlman, Gordon’s spokesman, said opioids aren’t just an addict’s problem. Their families and communities are affected too. 

“It causes extra burdens on our law enforcement agencies and first responders,” he said. 

Lodging tax clears first full House review

in News

By Cowboy State Daily

A proposal for a statewide lodging tax cleared an early hurdle in Wyoming’s House on Tuesday, while the Senate killed a bill that would have stiffened the penalties for animal cruelty.

Representatives, in their first full review of HB 66, agreed to move it forward to a second reading on Wednesday.

The bill would impose a statewide lodging tax of 5 percent, with 3 percent to be used to finance the state Tourism Division and 2 percent to go to local governments.

During its review of the bill, the House amended the measure to remove an exemption from the tax granted in the past for guides and outfitters.

Rep. Bucky Loucks, a member of the Minerals, Business and Economic Development Committee which reviewed the bill prior to its debate on the House floor, said he likes the fact that the measure would make the state Tourism Division self-supporting.

“The bottom line is tourism is a great part of Wyoming,” he said. “It’s our second leading industry and it needs to be there. I’d like to see (the Tourism Division) supported by the industry it benefits.”

In the Senate, members defeated by a vote of 21-7 a measure that would have doubled some of the penalties handed down for people convicted of animal abuse.

Senate File 33 would have increased the fine for misdemeanor animal cruelty from $750 to $1,500, with that fine rising to $7,500 for a second conviction.

The Senate did give final approval to a bill that would limit opioid prescriptions for some patients.

Senate File 46, approved on a vote of 27-3, limits doctors to providing a 14-day prescription for opioids for patients who have not had an opioid prescription for 45 days. Cancer patients and those with chronic pain would be exempt from the limits.

The bill now heads to the House for review by representatives.

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