Gov. Jay Inslee announced executive actions Friday aimed at preventing the overprescription and misuse of prescription pain pills, improving treatment availability for people dealing with opioid addiction, and making overdoses less deadly.
At a ceremony at the University of Washington Medical Center, Inslee instructed state agencies to work with tribal governments, nonprofits, law enforcement and other health-care groups to consider possible changes to state guidelines on when powerful and addictive painkillers should be prescribed.
Opioid overdoses killed an average of two people a day in Washington in 2015, part of an epidemic that has swept the nation in recent years, with, in many cases, pain-pill addiction segueing into heroin addiction.
“Opioid abuse is an equal-opportunity killer,” Inslee said. “It threatens all of our children, all of our families, in every corner of this state, at every economic level.”
Deaths from prescription pain pills in Washington have fallen consistently since 2009, but at the same time heroin deaths have skyrocketed, leaving the overall overdose death rate largely unchanged.
“We stop the heroin epidemic by attacking it at its source,” Inslee said, “the misuse and abuse of opioids in a legal sense.”
Heroin is, molecularly, almost identical to prescription opioids, and is generally much cheaper.
Inslee also ordered state agencies to work with Washington public schools to develop a strategy to teach kids about opioid abuse and to reduce the stigma around addiction.
Inslee said his office will work with health insurers to better include drug-treatment programs — including medication-assisted treatment like Suboxone — in health plans. He talked about increasing training for primary-care doctors so they will be better able to recognize addiction, in its early stages, in their patients.
Dr. Ray Hsiao, a specialist in addiction psychiatry at Seattle Children’s hospital and the past president of the Washington State Medical Association, said it was critical to better integrate basic medical care, mental health and addiction treatment.
“Now, a lot of times what happens, someone comes in to see their family doctor and talks about his issues, but they’re unable to get treatment for their addiction or for mental-health problems,” Hsiao said. “What we’re trying to do is get all three systems aligned together so people can get one-stop shopping.”
Inslee also instructed state agencies to help teach those dealing with addiction — be it prescription opioids or heroin — how to respond to an overdose. He told state agencies to work to improve the availability of naloxone — which reverses the effects of an overdose — and to teach people how to use it.
Inslee said agencies are looking at how much money in next year’s budget will be required for increasing naloxone access, boosting drug take-back programs and other initiatives that will require funding.
Inslee’s efforts coincide with a new urgency in the past year from the Obama administration to combat the opioid epidemic — both by reducing availability and increasing treatment options. The administration has asked Congress for an additional $1.1 billion for more treatment. Congress responded by passing a major new law aimed at addressing the epidemic, but with no new funding attached.
Nationwide, the Centers for Disease Control and Prevention recently released new guidelines for doctors, instructing them that opioids should never be the first choice for treating minor pain and, when they are necessary, should be prescribed in the lowest possible doses. Those guidelines are broadly similar to ones Washington unveiled in 2007.
And the federal Department of Health and Human Services, in an effort to ease access to medication-assisted opioid treatment, recently allowed doctors to treat more patients with buprenorphine-based drugs, like Suboxone and Bunavail. Previously each doctor could treat only 100 patients, but that number was raised to 275 earlier this year.
Earlier this week the federal Drug Enforcement Agency (DEA) announced that it would cut supplies of the most powerful prescription opioids by 25 percent next year. The DEA has the power to control the amount of prescription opioids that can be manufactured.
DEA limits on production of the most popular opioids (oxycodone, hydrocodone and morphine) were about four times higher in 2016 than they were in 2000.