State AG Ferguson releases report recommending strategies to combat opioid epidemic

State Attorney General Bob Ferguson on Tuesday released a report recommending specific policies to reduce the supply of opioids in Washington state.

The report recommends a comprehensive approach to the problem, addressing prevention, treatment and enforcement. Ferguson is also unveiling three opioid-related bills he will take to the Legislature in January.

The Attorney General’s Office, Washington State Patrol and the Washington Association of Prosecuting Attorneys developed the report based on information shared at the Summit on Reducing the Supply of Opioids in Washington State in June.

“The opioid epidemic is devastating Washington families,” Ferguson said in a state AG media release. “This report makes it clear we have a crisis, and provides concrete, evidence-based solutions. I am proposing some of these common-sense changes as legislation in the upcoming session, including limiting new opioid prescriptions and using the existing Prescription Monitoring Program to empower providers with a more complete picture of their patients’ history before writing new prescriptions. It is time for the Legislature to take action.”

On average, two people die each day from opioid overdoses in Washington state, according to the news release. In 2011, at the peak of overall sales in Washington, more than 112 million daily doses of all prescription opioids were dispensed in the state – enough for a 16-day supply for every woman, man and child in Washington.

At the opioid summit in June, Ferguson pledged he would put forward legislation consistent with the report’s recommendations. Ferguson announced on Tuesday he is introducing three agency request bills this session consistent with policy recommendations in the report.

One bill requires health care providers to check the state’s prescription-monitoring database before prescribing opioids. Another limits the number of opioids a provider can initially prescribe. A third bill gives the Attorney General’s Office Medicaid Fraud Control Unit more authority to investigate and prosecute opioid-related Medicaid fraud cases.

Prescription-monitoring program

Washington currently has a prescription-monitoring program in place to collect records when patients receive controlled substances such as opioids. This program, funded by public dollars, can flag misuse or dangerous prescribing patterns. Although pharmacies are entering all controlled substance prescription information into the database, only 30 percent of providers have registered to use it.

Ferguson’s legislation, sponsored by Sen. Kevin Van De Wege, D-Sequim, requires health care providers to check the prescription-monitoring database for a patient’s prescription history before prescribing opioids.

The report notes that some patients visit multiple providers to feed their addiction or to sell opioids for profit, a tactic known as “doctor shopping.” Requiring providers to check the prescription-monitoring program allows doctors to spot this behavior and refer these patients to treatment.

Currently, 30 states require providers to check their prescription-monitoring program before issuing prescriptions of opioids. After New York instituted a prescription-monitoring mandate, doctor shopping decreased by 90 percent. Research found no indication that those with legitimate medical needs had difficulty accessing medication.

Prescription limits

Ferguson is also proposing legislation, sponsored by Sen. Annette Cleveland, D-Vancouver, and Rep. Eileen Cody, D-Seattle, limiting initial opioid prescriptions to prevent overprescribing.

Prescribing more than a week’s supply of opioids approximately doubles the chance that the person will still be using the drugs one year later. Overprescribing leads to unused pills. If not disposed of properly, these opioids are available for misuse by teens and young adults. Prescribing only the lowest effective dose can prevent misuse, addiction and overdose, according to the report.

Based on the report’s recommendations, the proposed law limits initial opioid prescriptions to a three-day supply for those under 21 and a seven-day supply for those 21 and older. The bill makes Washington’s laws consistent with state Medicaid policy and CDC guidelines. According to the Centers for Disease Control and Prevention, for most conditions, a three-day supply of opioids will often be sufficient; more than seven days is rarely needed.

The bill exempts cancer patients, as well as palliative, hospice and other end-of-life care. Providers will have discretion to issue greater quantities of opioids if a patient’s medical condition requires it.

Medicaid Fraud Control Unit

Ferguson is introducing a third bill, sponsored by Rep. Roger Goodman, D-Kirkland, and Sen.-elect Manka Dhingra, D-Kirkland, that gives the Attorney General’s Office Medicaid Fraud Control Unit authority to issue search warrants and make arrests in Medicaid fraud cases, including those involving opioid misuse.

For example, one Medicaid fraud case involved a pharmacy technician who used his access to the pharmacy’s patient records to obtain opioids with high street value. These illegally diverted drugs were billed to the government.

Currently, since Washington’s Medicaid Fraud Control Unit is one of the few Medicaid fraud control units in the country lacking these critical law enforcement powers, it must rely heavily on the assistance of local law enforcement to carry out investigations. Providing these critical law enforcement powers will assist the unit’s investigations of dangerous ‘pill mill’ operations.

Other report recommendations

In addition to the Attorney General’s request legislation, the report outlines a range of recommendations for Washington state policymakers that address law enforcement, addiction treatment and prevention. These strategies include:

• Encouraging pain relief alternatives. For most conditions, non-opioid pain treatments such as ibuprofen and acetaminophen are equally or more effective with significantly less risk than opioids.

• Expanding drug take-back initiatives. One study of medicine take-back events found more than 60 percent of opioids originally dispensed go unused. Secure drop boxes, particularly those conveniently located at pharmacies, help keep unused drugs out of the hands of youth or criminals.

• Drug courts. Drug courts can reduce prison sentences for those who receive drug treatment, making them less likely to reoffend.

• Law enforcement assisted diversion programs. A King County law enforcement program diverts those arrested for nonviolent offenses, such as drug possession, into treatment and support services. Program participants are 87 percent less likely to go to prison than those within the traditional criminal justice system.

• Enhanced penalties for trafficking strong synthetic opioids such as fentanyl. Fentanyl, a synthetic opioid, can be deadly even in small doses—a few salt-sized grains—and is more than 100 times more potent than heroin.

• Increased funding for drug-gang task forces. In 2014, Washington’s drug task forces disrupted or dismantled more than 150 drug trafficking organizations. However, since 2015, they have received no state funding.