Confronting the Opioid Crisis: Six Bills Build Momentum for Legislative Changes

Between 2012 and early 2017, I was part of a policy team at the Department of Health and Human Services (HHS) that helped to advise then-Secretary Sylvia Burwell on a wide range of health policy topics, including the best available evidence to combat the opioid epidemic.

It was an important task. Drug overdose deaths claimed more than 52,000 lives in the U.S. in 2015 alone, with more than 33,000 from opioids. To put that in perspective, at the peak of the AIDS epidemic in 1995, the disease claimed 51,000 lives.

I met with more state legislators, providers, insurers and members of professional associations than I can count over my years at HHS. But the memories of families that lost loved ones to overdoses truly stuck with me.

Now, back in Colorado and working at the Colorado Health Institute as a policy analyst, I’m again working on the opioids issue. As part of that effort, I’m tracking the state’s response to the prescription drug and heroin crisis, which has claimed the lives of more than 5,000 Coloradans since 1999. Colorado lost 472 lives to some type of opioid in 2015, and the early data from 2016 show these figures heading higher.

The Colorado General Assembly is poised to launch a policy offensive against opioid abuse. This summer, the legislature formed the bipartisan Opioid and Other Substance Use Disorders Interim Committee to hear recommendations and develop potential solutions to confront the challenge of a generation.

It conducted five hearings, three task force meetings and additional stakeholder meetings between July 10 and October 31. Led by Chairwoman Rep. Brittany Pettersen (D-Lakewood) and Vice Chairman Sen. Kent Lambert (R-Colorado Springs), the 10-member bipartisan committee produced six pieces of draft legislation aimed at improving prescribing practices, increasing access to treatment and reducing the harms (such as infectious disease) associated with drug use.

The bills, which will be introduced early in the 2018 session, come with a price tag. While that frequently spells disaster for proposals in the state legislature, the strong bipartisan committee backing means that all of them should have a chance to pass. Since the bills have not yet been introduced, they have temporarily been assigned letters to identify them on the General Assembly’s website.

Bill A

Goal: Improve opioid prescribing practices and access to substance use treatment for students.

Would establish the bipartisan group as a year-round study committee through 2023, which means additional staffing and resources to continue the work. The bill directs the University of Colorado hospital authority to develop continuing education requirements around safe prescribing of opioids for pain; allows school-based health centers to fund treatment for substance use disorders (SUD); and modifies the requirements of Health First Colorado (Medicaid) Screening, Brief Intervention and Referral to Treatment (SBIRT) grant program. The SBIRT model is an evidence-based practice to help health care professionals identify and reduce problematic substance use.

• Status: Passed 10-0 out of committee

Bill B

Goal: Reduce the number of opioids being prescribed.

Would limit opioid prescriptions to no more than seven days’ worth at a time, with exceptions for cancer, palliative care or post-surgical pain, among others. It would also allow prescribers to submit opioid prescriptions electronically to pharmacies and require prescribers to check the prescription drug monitoring program (PDMP) before issuing refills. The PDMP is a database that allows providers to keep track of their patients’ medications. The seven-day limit mirrors changes made by Massachusetts, Maine, Connecticut and other states. Health First Colorado, the state’s Medicaid program, also limits opioid prescriptions to seven days. However, the medical community has expressed concerns about a statutory one-week limit, pointing to the need for flexibility between patient and provider.

• Status: Passed 9-1 out of committee, with the lone “no” vote from Rep. Perry Buck (R-Windsor)

Bill C

Goal: Reduce the risk of infectious disease and drug overdoses.

Would allow county and district public health agencies to provide access to clean syringes (known as syringe exchange programs) without prior approval. It also would allow hospitals to operate syringe exchange programs and exempt supervised injection facilities from public nuisance laws. These changes are intended to reduce the risk of infectious disease by allowing more access to clean needles and to reduce the risk of overdose by allowing localities to create a safe place to inject drugs.

• Status: Passed 10-0 out of committee, with bipartisan support.

Bill D

Goal: Increase the number of behavioral health providers in Colorado.

Would broaden the list of health care providers eligible for the Colorado Health Service Corps (CHSC) program, which helps repay the student loans of providers who work in rural and underserved areas. The list would include licensed clinical social workers, licensed professional counselors and clinical psychologists, among others. It also creates a scholarship program to cover the costs of becoming a certified addiction counselor for those who agree to work in underserved areas. The bill appropriates $2.5 million in the first year for these two programs and would require annual appropriations each year after that. It would also add SUD provider representation to the advisory council that makes recommendations about administering the CHSC program.

• Status: Passed 10-0 out of committee

Bill E

Goal: Expand access to substance use treatment in Colorado’s Medicaid program.

Would direct Colorado’s Medicaid program to seek a federal waiver to receive matching funds for residential and inpatient treatment for substance abuse. These services have been mostly ineligible for federal Medicaid dollars due to a long-standing prohibition. However, the feds recently issued guidance on how states could use a waiver to request funding. Stakeholders widely supported the addition of this important service to Health First Colorado’s benefits, but the state’s cost is estimated to be nearly $500,000 next year and potentially tens of millions of dollars in future years.

• Status: Passed 10-0 out of committee

Bill F

Goal: Expand access to medication-assisted treatment (MAT) and reduce unnecessary opioid prescribing.

Would allow health professionals to prescribe MAT for Health First Colorado enrollees and those with private insurance without first seeking approval from a patient’s insurer, a requirement known as prior authorization. It also prohibits plans from requiring a person to try an opioid before covering a non-opioid prescription, commonly known as “step therapy.” Removing the prior authorization requirement for MAT could help more people access treatment, while requiring plans to cover non-opioid alternatives without step therapy could help reduce unnecessary opioid prescribing.

• Status: Passed 7-3 out of committee, with “no” votes from Rep. Perry Buck (R-Windsor), Rep. Clarice Navarro (R-Pueblo) and Sen. Jack Tate (R-Centennial)

Here at CHI, we’ll be closely watching the progress of these six bills next session, along with many others. We will also be talking about the opioid epidemic at our Hot Issues in Health conference on December 7 and are planning much more work in this area in 2018, so stay tuned for new analysis.