Delaware Secretary of State Jeffrey Bullock has proposed stricter regulations for the prescribing of opioid analgesics to help stem the tide of opioid prescription drug abuse and addiction.

The regulations include three major provisions:

• For an acute injury or procedure, a practitioner can prescribe a maximum initial seven-day supply of an opioid medication before additional steps are required.
• Prescribing beyond a seven-day supply or for additional prescriptions after the first seven-day supply, the practitioner will be required to check the patient’s prescription history in the State’s Prescription Monitoring Program (PMP) along with obtaining informed consent from the patient for risks of such things as potential addiction, abuse, misuse, and risks of life-threatening respiratory depression and accidental overdose, which can be fatal.
• For patients being treated for chronic pain, practitioners will be required to check the State’s PMP and administer a urine drug screening at least twice a year while receiving chronic treatment with opioid medications. The practitioner must also consider and discuss alternative treatment options with a patient, and conduct a risk assessment to identify patients that are or may be at risk for dependence or misuse of a prescribed opioid. A signed treatment agreement will also be required to be in place for these patients.

“These new regulations recognize the undeniable link between prolonged prescriptions for opioids and the addictions that can result from their overuse. The regulations are also an acknowledgement that opioids are a gateway to the abuse of illegal drugs, especially heroin. Many individuals struggling with opioid addiction have indicated that it started with an injury or medical procedure and a prescription for opioids such as Percocet or Vicodin. The proposed regulations lay out requirements for the safe prescribing for both instances of acute pain as well as chronic, long-term conditions involving pain treatment,” said Secretary Bullock.

The regulations are the result of months of research and work by the Secretary’s Controlled Substance Advisory Committee, and input from various individuals and groups during an initial Public Comment and Hearing period last year. They also follow recommendations recently issued by the Centers for Disease Control (CDC). The proposed regulations are available for review during another Public Comment period through May 31, 2016.

These proposed regulations will apply to any Delaware licensed practitioner also licensed to prescribe controlled substances. These include physicians, physician assistants, advanced practice nurses, podiatrists, and dentists.

Nearly two million Americans abused or were dependent upon prescription opioids in 2014. 90 percent of heroin users indicate they started with prescription opioids. Overdoses from heroin, prescription painkillers, and other drugs led to the deaths of 171 Delaware residents in 2013, or about one person every other day. According to preliminary numbers, 204 Delawareans died of drug-related deaths in 2014.

To address the issue of opioid use and chronic pain treatment nationally, the CDC recently released new chronic pain management guidelines which are consistent with the new Department of State regulations. The goal of both is to improve the way that opioids are prescribed to ensure patients have access to safer, more effective chronic pain treatment while reducing the number of people who misuse, abuse, or overdose from these drugs.

“Prescription drug abuse is a public health crisis and opioids should never be the first line of defense to treat chronic pain,” said Dr. Karyl Rattay, Division of Public Health Director and Prescription Drug Action Committee co-chair. “We must take a multi-faceted approach to combating this complex problem, including offering a variety of interventions to manage chronic pain, and provide medical providers the tools and resources they need to make the best prescribing decisions in partnership with their patients.”

“The addiction epidemic is taking a terrible toll on individuals and families across our state, including accidental overdose deaths, hospitalizations, babies being born addicted, homelessness, families in crisis, and many other challenges,” said Department of Health and Social Services Secretary Rita Landgraf. “We must reduce the pipeline to prescription drugs while ensuring that legitimate pain needs are met. With every step, we will support medical providers in their efforts to reduce opioid prescribing.”

Opioids can be a problem not only for those prescribed the drug, but national studies show that more than two-thirds of people who misuse prescription drugs get them from friends and family, including raiding medicine cabinets, purses, and drawers.

Many other initiatives have been underway in Delaware over the past few years to address such things as safe disposal of unused medications, implementation of a state prescription monitoring program, education of practitioners on prescription drug abuse, increasing access to substance use disorder treatment and most recently, more ready access and use of the overdose reversal drug, naloxone. Providing regulations around best practices in patient care when prescribing opioids is aimed squarely at prescribing to reduce exposure to opioids, prevent abuse, decrease the rate of dependence and addiction, and ultimately lower the number of prescription drug-related overdose deaths.

Persons seeking help for drug addiction can visit www.HelpIsHereDE.com to connect with treatment and recovery services. The website also includes warning signs of addiction. For further information on the Prescription Drug Action Committee, visit: http://dhss.delaware.gov/dhss/dph/pdachome.html.

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