Overdose Deaths

Hydrocodone pills, also known as Vicodin, are arranged for a photo at a pharmacy in Montpelier, Vt. on Tuesday, Feb. 19, 2013

Virginia’s Board of Medicine has approved new emergency regulations that will give it authority to specifically regulate the prescribing of opioids for pain.

The board’s decision was made in response to the state’s ongoing opioid epidemic. Opioids are a type of drug that includes both prescription painkillers and illicit drugs such as heroin.

According to the Virginia Department of Health, the state saw 822 opioid overdose deaths in the first nine months of 2016, compared with 811 in all of 2015.

“Almost three people a day are dying in Virginia from an opioid overdose, either prescription or illegal,” said David E. Brown, director of the state’s Department of Health Professions.

The Board of Medicine voted on the new regulations Thursday, and they will go into effect within the next month after receiving the governor’s signature.

The regulations for the first time apply specific guidelines to Virginia providers, dictating how many opioids can be prescribed depending on the situation and stipulating that other pain treatments should be considered before opioids are prescribed.

Before prescribing opioids, providers must do a thorough physical examination and determine the patient’s history. The patient also must be given Naloxone — an overdose-reversal drug — should the physician determine they have overdose risk factors or a history of substance abuse.

“It’s a very complex system, and our intent is to make sure that we encourage better prescribing so we can hopefully ensure that patients don’t turn to street drugs,” said Ralston King, senior director of government affairs with the Medical Society of Virginia, which helped to develop the new guidelines.

In 2015, deaths from illicit opioids such as fentanyl and heroin surpassed those caused by prescription opioids, but the new guidelines are meant to prevent patients from abusing prescriptions so they do not eventually turn to illicit alternatives.

“What’s really important about all this is that there are simply a lot of prescriptions written for opioids, not just in Virginia but across the country,” Brown said. “Last year, nationally, enough opioid prescriptions were written to give every adult in America a bottle of pills.”

The push for the Board of Medicine to adopt new regulations came from several sides, Brown said, including Gov. Terry McAuliffe and Secretary of Health and Human Resources Bill Hazel, who requested that the board consider the issue.

Virginia’s regulatory town hall website indicates the new regulations were put in place as a response to the public health emergency that Marissa Levine, the state’s commissioner of health, declared in November.

Brown said several bills were proposed during this year’s General Assembly session that address the opioid epidemic, so the board decided to include those initiatives in its new regulations, including creating a seven-day prescription limit for opioids prescribed for acute pain, such as from broken bones.

“The idea was to have physicians make decisions about regulations as opposed to legislators,” Brown said.

Sen. A. Benton Chafin Jr., R-Russell, and Del. Todd E. Pillion, R-Washington County, both have proposed numerous bills related to opioids, including matching bills that would create a work group to establish opioid prescription guidelines for health care providers in training.

“I’m absolutely thrilled with the Board of Medicine’s decision to implement the regulations that take a strong stance on what we’ve seen developing not just in our region in Southwest Virginia but throughout the commonwealth,” Chafin said. “We can ill afford to lose a generation of young people.”

In a prepared statement, Pillion called the new regulations “another tool in this important fight.”

The Board of Medicine’s new guidelines also address the prescription of buprenorphine, a drug used to treat opioid addiction that in some parts of the state is the new top street drug. In Southwest Virginia, it is prescribed at eight times the national average.

“We want patients to find appropriate medications and get off opioids, and a piece of it is counseling and assisted treatment, not just using buprenorphine,” King said.

The opioid epidemic has resulted in various public health problems in addition to skyrocketing overdose deaths.

The state has seen a significant rise in cases of hepatitis C, which is spread easily through injection drug use.

In 2010, there were 2,800 cases of hepatitis C in the state; about 9,000 cases are expected to be counted in 2016, according to Department of Health officials.

Cases of neonatal abstinence syndrome, in which babies are exposed to drugs in utero and experience withdrawal after birth, have spiked in the state as well.

In fiscal 2016, the number of children exposed to drugs in utero increased 21 percent to 1,334, according to the Department of Social Services.


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