Mixed outcomes for opioid bills

State lawmakers are taking aim at the opioid crisis this session largely through education initiatives and regulations on prescribing of opioids, letting some of the more controversial bills — like those that would have protected drug addicts who call to report overdoses and legalized needle exchange programs — die in the House and Senate.

Legislation by Rep. Garnet Coleman, D-Houston, that would have given Texas counties the authority to decide whether to make programs that hand out syringes to drug users legal, did not make it to a vote in the House.

"I've been working on needle exchange for a long time," said Coleman, who has introduced similar bills in the past and said this one made it the farthest. "The unfortunate thing is that there is this opinion, that’s disproven through research, that needle exchange or syringe exchange encourages the use of drugs. … It’s sad because the very thing we need to do is what we’re not doing. And it’s going to get even worse. More people are going to start using heroin."

None of the bills that would have protected drug users who call to report drug overdoses from prosecution got hearings either, despite advocates saying that the measure would lead to a significant drop in overdose deaths, as seen in other states with such laws. A similar bill was passed with widespread support in the House and Senate in the last legislative session but was vetoed by Gov. Gregg Abbott, who said it did not include provisions to "prevent its misuse by habitual drug users and drug dealers."

Most of the bills that have gotten preliminary approval by lawmakers so far recommend additional education for doctors and patients about prescribing opioids and addiction. Other bills with preliminary approval would eliminate barriers to accessing medication-assisted treatment — including the drug buprenorphine, which is used to treat opioid addiction — and drugs that reverse the effects of an opioid overdose.

On Thursday, lawmakers gave final approval to a bill that will amend the Texas Education Code to require local school health advisory councils to make recommendations about ways to teach kids, at appropriate grade levels, about opioid addiction and how to administer the opioid overdose-reversing drug naloxone.

More than 47,000 people died of overdoses involving opioids in the U.S. in 2017, and drug overdoses generally went up 4% in Texas from 2016 to 2017, U.S. Centers for Disease Control and Prevention data show.

Opioid prescription limits

Because of the increasing number of deaths, Texas lawmakers last year decided to take a look at the state's drug problem. In a 108-page report issued in November, they made nearly 100 recommendations on how to tackle the issue.

"You see a fair amount of opioid bills out there to deal with the problem we are facing," said Rep. John Zerwas, R-Katy, the author of one of the bills filed this session. "There’s no doubt that the opioid-related deaths have risen significantly. There are some things from a policy standpoint I think we can do."

Zerwas' bill, House Bill 2174, is still being considered by lawmakers and would limit opioid prescriptions for acute pain to a 10-day supply. He said this would prevent patients from staying on the medications long term and becoming addicted and would reduce the number of unused pills in homes that could be taken by someone else. 

The bill would also require electronic prescriptions for all opioid medications to curb the number of fraudulent prescriptions. Experts have testified that 4% of opioid prescriptions in Texas — or about 1 million prescriptions each year — are fraudulent.

The bill passed the House by a 129-4 vote and is now in the hands of the Senate Health and Human Services Committee.

Lawmakers debated with stakeholders for several weeks about the opioid prescribing limits, which at first had restricted them to a seven-day supply. Some doctors said that many of their patients are experiencing multiple traumatic and life-threatening injuries and need prescriptions for longer periods. They lobbied for the limit to be increased to 14 days.

Zerwas settled on the 10-day limit, with no refills.

"The truth of the matter is a lot of the physicians are already limiting the amounts of opioids that they are prescribing," he said. "I think this is meant to sort of catalyze that a bit and to really kind of move it to the next level as opposed to just a voluntary effort on their part."

Other solutions

The limits would not apply to patients who are receiving opioids for chronic pain, cancer or end of life care.

Some chronic pain patients still oppose the legislation, though, saying that any supply limits interfere with the doctor-patient relationship and that it should be up to a physician to decide how much medication is appropriate.

"These prescribing limits aren’t solving the problems they are meant to solve. They are causing harm," chronic pain patient Kristin McGarity testified at a March 20 House committee hearing. "We need to be protecting patients through all stages of illness. Not everything heals in seven days. Not everything heals at all. The way to do it is with documentation requirements and reevaluation at regular intervals, not necessarily number of days or number of pills per dosage."

Similar limits have been proposed at the federal level, limiting opioid prescriptions to a seven-day supply.

Zerwas said he knows that many people who suffer from chronic pain seek out illicit drugs when they are cut off from medications.

"That's the balance you have to play," he said. "If you over-restrict the amount of medication a physician can prescribe to a patient, and the physician is not going to be friendly to refilling, you are essentially moving that person into the unregulated market."

HB 2811, filed by Rep. Four Price, R-Amarillo, would also regulate the prescribing of opioids for acute pain, but does not include supply limits. It would simply require doctors to discuss the risks of the medications with their patients, including how to safely store and dispose of them.

Price has also introduced legislation that would require doctors to receive additional training every two years in the prescribing of opioids for chronic pain, including what other options they could consider as alternatives to addictive medication.

Both measures were given preliminary approval by the House and are being considered in the Senate.

HB 3285, by Rep. J.D. Sheffield, R-Gatesville, includes a number of other provisions to combat the opioid crisis that were suggested by lawmakers last year, including expanding access to the opioid overdose-reversing medication naloxone, providing reimbursements for people seeking medication-assisted treatment, and improving the state's data collection so medical examiners in Texas are able to accurately tally the number of opioid-related overdoses.

The legislation was passed in the House and is being considered by the Senate. The deadline for the Senate to give final approval to House bills is Wednesday.