State must block opioid epidemic

Opioid addiction seems to have sprung into national consciousness, in part because of Capitol Hill discussions of health-care reform. However, this crisis didn’t develop in a vacuum, and combatting it will require attention at every juncture where these pain-killing drugs fan out across the prescription and illicit- drug spectrum.

The encouraging part for Hawaii residents is that the state is positioned to grapple with its own problem before it morphs into the emergency it’s become in other regions, where people are dying and their plight has loomed as a public-health failure. There is some money allotted, and a comprehensive opioids plan should soon emerge.

Hawaii ranks 43rd in the nation in drug overdose deaths, in general; specifically, illicit opioid abuse is one-fifth of what the crystal methamphetamine problem still remains.

But even if it hasn’t reached the critical levels it has in West Virginia, Ohio and elsewhere, the public health system of this state needs to have a response ready.

This week, Gov. David Ige announced a plan to distribute 20,000 opioid overdose rescue kits. Health care providers, first responders, pharmacists and others need to be equipped to intercede quickly in an overdose emergency and save lives.

On a separate front, the state Legislature and the governor enacted a bill to better control opioid prescriptions. Senate Bill 505, which became Act 66, mandates that health-care providers practice informed consent in the delivery of opioid therapy.

In other words, patients need to know how addictive these substances are and the limits of their usefulness in treating their acute pain symptoms.

Providers also must limit prescriptions of opioids and benzodiazepines, another class of drugs, to a maximum of seven consecutive days, except for specified conditions.

More needs to be done legislatively. An existing state program for doctors registering in a database must be enforced; this would enable better tracking of the prescriptions of these drugs to patients who may move from provider to provider.

But this is a good start, at the supply side, before the overprescription of opioids becomes epidemic.

Further, a total of $11 million in three federal grants is available, and the state Department of Health is drawing up a comprehensive plan for heading off a crisis in Hawaii.

Eddie Mersereau, chief of the department’s Alcohol and Drug Abuse Division, said the lion’s share of the funding, about $8.5 million, is a grant focused on screening, intervention and referral to treatment.

Exactly how the funding will be spent is yet to be fleshed out, but the approach involves outreach to physicians and urging that patients be screened for health risk factors that make opioid addiction a particular hazard, Mersereau said. For example, the patient may have a separate alcohol abuse problem, and the interaction of those drugs is to be avoided.

There is an additional $2 million for public education and helping law enforcement with interdiction of illicit drug sales. The $500,000 is largely for preparation of a needs assessment, a broad study to determine the scope of the problem.

Lawmakers also are working on a statewide plan to guide implementation. Policy proposals will be presented to the 2018 legislative session.

Hawaii may face less of a steep climb in warding off the tragic outcomes of opioid addiction, but it must not be ignored. There are Health Department statistics that are worrisome. Drug overdose accounts for 23 percent of all fatal injuries and is the leading form of injury-related deaths here. Heroin overdoses here are on the rise, mirroring the national trend.

Hawaii’s actions to reverse such trends are timely, and deserve to be supported and amplified in the coming years.