Toughen laws on prescribing opioids

Everyone needs to be worried about the statistics on the opioid addiction epidemic — in Hawaii as well as nationally. Even those who feel remote from this crisis need to see that it’s become a mounting burden on the health-care system, as well as a disaster for families.

And much more needs to be done to rein in what’s become a class of drugs too freely available to patients. This starts with enactment of a new law ensuring patients are better informed of the risk of these powerful pain-killing drugs — and with enforcement of earlier legislation aimed at better oversight by physicians.

The new law is Senate Bill 505, passed in the 2017 session. If Gov. David Ige signs it into law as he should, it would help to tamp down the demand for opioids because patients would know better the dire consequences of abuse.

The law would require that, starting in July 2018, providers that prescribe the drugs develop a written “inform and consent” policy with patients. That policy would involve securing a written agreement by a patient to use the drugs and understand all the repercussions.

It essentially constrains opioids and benzodiazepines, a psychoactive drug, from being prescribed for longer than seven consecutive days, lessening the addiction risk.

Of course, any new law is only as good as its enforceability, and this one has various carve-outs. There may be cause to revisit the issue at the outset of the next session. Lawmakers should seek a status report on the development of this policy from medical service providers and look for ways to strengthen the law.

Legislators also need to revisit the statute mandating physicians to enroll in a database that would help the state monitor prescription drugs. Only about a 10-20 percent of physicians required to sign up have done so.

Doctors need to weigh in and identify any barriers to enrollment they’ve encountered; it’s critical that this system be optimized. There is no way to curb abuse of these drugs if there’s no effective tracking mechanism.

Here is why this has become an acute problem: Emergency room visits and hospitalizations in Hawaii have doubled over the past 10 years, due to an overdose on heroin or prescription drugs.

The numbers are staggering: Last year, a total of 4,017 patients ran up more than $110.7 million in hospital bills due to opioid issues. That toll was only $48.7 million billed for 2,797 patients in 2010. The data come from the Hawaii Health Information Corp.

The connection is plain: People who become addicted to a drug can more readily overdose, driving them to emergency rooms where treatment is very expensive.

What is looming as a further threat to the health-care system is the fate of the Affordable Care Act. This week the Republican-led U.S. Senate accelerated plans to roll back the provisions of the ACA, also known as Obamacare, the signature legislation of former President Barack Obama.

The GOP legislation is being crafted by a select group behind closed doors — unacceptable for a law that will affect such a large swath of the population. And what little is known about the draft should set off alarms in every state where opioid addiction is a problem.

The ACA’s expansion of Medicaid is enabling many people to access treatment for their addiction, but that coverage is likely to be phased out, if the bill becomes law. States will be left to pick up the tab for the newly uninsured; patients will turn to the ER for treatment, and hospitals inevitably petition aid from state coffers in recouping their losses.

This is a public health calamity in the making. Hawaii needs to do what it can to break the opioid cycle where it starts: with every prescription a doctor writes.