As Nevada implements steps to combat opioid crisis, Sandoval convenes task force to check progress
Combating opioid abuse has been one of Gov. Brian Sandoval’s top priorities over the last few years — and promises to remain one even as he enters his final months in office.
The governor called a second meeting of his Opioid State Action Accountability Task Force on Wednesday to receive an update on the state’s four-pronged response to the opioid crisis, which claimed the lives of 387 Nevadans in 2016, according to preliminary estimates. Various state agencies and community organizations each came forward to present their small piece of the overall effort, from prescriber guidelines to criminal justice interventions. (Sandoval was at a National Governor’s Association event and was unable to attend the meeting, but it was presided over by his chief of staff, Mike Willden.)
Though the opioid epidemic remains a serious problem, Nevada was actually one of only two states that has taken action as of the end of 2017 on what the National Safety Council determined as six “key actions” for ending the opioid crisis, including educating prescribers, creating prescription guidelines and treating overdoses, among others. It is also only one of seven states that has improved the way it collects and shares data related to the opioid crisis.
With less than a year left in office for Sandoval, here’s what’s currently being done to combat the opioid epidemic.
Prescriber education and guidelines
A new opioid prescribing law caused much consternation within the physician community in Nevada when it went into effect on Jan. 1, with some doctors saying the law is vague at best and impossible to comply with at worst. Even state Sen. Joe Hardy, a physician by trade, expressed concern at the time over a set of proposed regulations related to the law, saying that when he voted in favor of the bill — “flawed as it was” — he “felt a certain level of comfort” that the issues would be worked out in the regulatory process, but that instead the regulations were “raw and they rub the providers raw.”
Now, four months later, Hardy shared several anecdotal stories with the task force about how the law has allowed him and other doctors to have “candid, frank discussions” about their pain medications. He said one patient came in to see him after her pain doctor went on vacation, and she went into withdrawal. Hardy said the patient had told him that she felt about the same going through withdrawal as she did when she was on the pain medicine, so he decided not to write her an ongoing prescription for the medicine.
“I said, ‘I’m not going to write that anymore.’ She said, ‘I dreamed of this day,’” Hardy said. “I saw her back, and she’s doing very well.”
Hardy said that there are still “probably wrinkles to be ironed out” but that he looks forward to helping do so.
To assist with the implementation of the law — which requires ongoing education for prescribers and dictates the steps doctors are required to take before writing short- and long-term prescriptions for opioids — the Board of Pharmacy facilitated the creation of a white paper along with input from the other medical licensing boards to describe what the bill does in plain language and a set of frequently asked questions. The boards and other medical groups also focused on educating prescribers at a host of workshops and training sessions at hospitals and universities to make sure that doctors and others were aware of how the new guidelines would affect their practices
But Board of Pharmacy Deputy Executive Secretary Dave Wuest acknowledged the difficulties that arose early in the process, including concerns and misinformation among patients and providers about what the bill did or did not require and the need for further public education and outreach. He also noted the need for more resources for patients who are seeking alternative pain management.
Future priorities related to prescriber education and guidelines include identifying needs for new or revised regulations within the licensing boards, analyzing and making accessible new data in the state’s prescription drug monitoring database, known as the PDMP, and ensuring that prescribers and the public are educated about the new requirements in the bill. Additionally, the Board of Medical Examiners, which licenses M.D. doctors in the state, may host one or more free webinars on best practices for doctors, publish a newsletter with best practices and continue to support doctors’ compliance with the new law.
Separately, the state is working on a set of permanent regulations related to the statewide reporting of opioid overdoses as required by the new law. Sandoval approved emergency regulations on Jan. 17 to get the process started, and Julia Peek, deputy administrator for the state Division of Public and Behavioral Health, said a public workshop on the permanent regulations will be held on March 22, with a Board of Health hearing scheduled for May 4.
Peek told the task force that the the state has already been receiving both paper and electronic reports of opioid overdoses under the framework of the emergency regulations, with about 300 reports collected so far, which she said “feels low” compared to insurance claims data. She said that several hospitals have been reporting electronically on behalf of their physicians, including Renown in Reno, Banner-Churchill Community Hospital in Fallon, Northeastern Nevada Regional Hospital in Elko and UMC in Las Vegas.
She said that the state will “do a huge push” to make sure overdoses are getting reported once the permanent regulations are in place.
Treatment options and third-party payers
Nevada has been working on implementing so-called Integrated Opioid Treatment and Recovery Centers, awarding state targeted response grants to three different organizations to serve as the hub for opioid treatment. The state awarded grants to the Center for Behavioral Health, which has four sites in Las Vegas and one in Reno; the Life Change Center, with one site in Sparks; and Vitality Unlimited, with one site in Elko.
Each center is responsible for consulting on opioid use disorder treatment, providing Medication Assisted Therapy and recovery services, as well as developing broader networks of care. The grants to each center were funded through the federal Substance Abuse and Mental Health Services Administration.
“The cooperative care model is really a grassroots effort where organizations begin to develop formal and informal networks within their communities,” said Dr. Stephanie Woodard, the state’s senior advisor for behavioral health.
She said that the first year of the grant was focused on establishing the hubs — that is, each individual center — and the second year will target developing the spokes and expanding the network of resources each center has to rely on. The state is working on a possible Medicaid waiver that would give the state additional flexibility to provide coverage for treatment of certain opioid use disorders, Woodard said.
The state is also responsible for purchasing naloxone or Narcan, two drugs that can reverse an opioid overdose, and distributing those to law enforcement and the integrated opioid treatment centers. According to the attorney general’s office, 22 agencies in Nevada have received 1,155 doses so far, and Woodard said another 195 have been distributed to the treatment centers.
Data collection and intelligence sharing
Another priority is collecting and sharing data on the opioid crisis statewide, which it has done in conjunction with the Southern Nevada Health District in the form of a state opioid dashboard. Other projects include a Web Infrastructure for Treatment Services data system, data sharing of the criminal history repository the Department of Health and Human Services and the Department of Protection and overdose reporting as required by the new opioid law.
Upcoming priorities include preliminary analyses of the criminal history repository and the new overdose data.
Criminal justice interventions
The state has also made strides to address the criminal side of the opioid crisis, first and foremost by hiring a law enforcement coordinator within the attorney general’s office. The office has also hired a criminal investigator position, funded by a 2016 federal court settlement with Volkswagen, who is assigned to the Federal Bureau of Investigation’s health-care fraud task force.
The Department of Health and Human Services also received $250,000 from the Volkswagen settlement to purchase naloxone and Narcan, and other settlement money is paying for the purchase and installation of five opioid incinerators, located in Boulder City, Elko, Mineral County, Nye County and Storey County.
Future criminal justice priorities include identifying law enforcement practices that are working within certain communities to share statewide, exploring the use of an opioid overdose map to monitor overdoses and providing general public education and awareness about safe disposal of excess medication.