The House Select Committee on Opioids & Substance abuse has published its interim report to the 86th Legislature.
The committee held a series of hearing during the interim, each focusing on a set of topics, including a review of opioids and substance abuse generally, impact of substance abuse on the Child Protective Services System, impact on certain populations, state agency guidelines and monitoring, prescribing practices, and impact of opioids on law enforcement and first responders. For full details, including summaries of each hearing and conclusion, please see the full interim report.
Spotlight on Recommendations
Public Hearing 1: Charge 1 – Overview of Opioids and Substance Abuse
- Reverse “Pain as the Fifth Vital Sign” by formal declaration (resolution).
- Continue the emphasis on integrated care to provide care for the whole person and not separate physical health from mental health.
- Continue the effort to ensure parity laws are enforced.
- Require following the Centers for Disease Control (CDC) guidelines for days or dosages of an opioid prescription, with applicable exceptions.
- In continued review of methods to reduce the abuse of opioids and other drugs, recognize and fully consider medically appropriate and legitimate uses of opioids.
- Consider the potential unintended consequence of increased use, abuse and overdose of heroin and fentanyl due to opioids no longer being available to some patients because prescriptions are harder to obtain, and/or prescription medication is more expensive.
- As emergency departments write a large number of prescriptions, encourage following the emergency department guidelines generated by the Texas Hospital Association.
- Identify methamphetamines as a Texas crisis, due to some parts of the state having more prevalence of methamphetamine use and abuse than opioids – give weight to extreme ease of use, addictiveness, and social, criminal and health-related costs associated with this powerful substance.
- Treat substance use disorder (SUD) as a chronic illness.
- Increase availability of and access to opioid antagonists.
- Encourage MAT treatment centers to include on-site mental health providers, for a “one-stop shop,” for co-occurring conditions.
- Expand the state’s definition of MAT, to include more treatments and more opioid antagonist options on the Preferred Drug List (via the Vendor Drug Program and Drug Utilization Review Board).
- Encourage an increase in the number of prescribers of MAT medications.
- People suffering from opioid use and/or SUD need access to MAT options available in all counties of the state – expand treatment options in medically underserved areas to ensure an adequate network of prescribers and providers to reduce geographic gaps in treatment availability.
- Encourage development of new non-addictive medications that will work on the brain’s opioid receptors.
- Review funding rates to substance abuse service facilities as capacity to provide treatment is impacted by rates and the current rates do not support growth. Perform a comprehensive rate study based on best practices for each level of care to determine the best rates for recommendation.
- Evaluate scope of recovery support services including recovery housing and recovery coaching, including possible enhancements.
- Consider the need for continuum of services that are flexible to individuals and communities to improve service delivery and reduce recidivism based on evidenced-based best practices.
- Encourage prescribers to advocate for other pain management methods; make opioids a last resort.
- Determine how to obtain data in a more real-time manner to better address progress and gaps of programs.
- Improve data content and accuracy by standardizing reporting across all agencies related to opioid and substance abuse, for better data, analysis, and communication.
- For accuracy in correct cause of death declarations, require training programs to anyone who has the authority to issue a death certificate’s cause of death but is not a medical professional to ensure the person knows what the symptoms and conditions are in an overdose fatality.
- Consider methods for improved data sharing with various stakeholders, including insurance companies, prescribers, dispensers, and others as appropriate, for coordination of access to data and client information to identify trends.
- Prevention is key to reducing first incidence and recurrence of substance use disorders and should be available across one’s lifespan; provide education in school and community environments.
- Strengthen schools’ curriculum with specific regard to substance abuse in Health classes in middle and high schools across the state.
- Generate awareness campaigns similar to “Drinking and Driving” campaigns, to include public service announcements regarding not only risk of opioid and drug addiction, but also risk of over-sedation, respiratory depression, mixing medications, etc.
- Consider the employment of prevention specialists in public schools.
- Require a list of local, evidence-based drug education and prevention programs be provided to TEA for distribution to all school districts.
- Promote education regarding safe storage and safe disposal of unused medications.
- Expand drug take back programs and encourage that every pharmacy and hospital have a secure, consistent, and anonymous collection point for unused medications.
- Encourage pharmacy follow-up where a pharmacist calls to check on a patient regarding use of a prescription and if all was taken; if not, what happened to the medication, as in, was it thrown out, left in a cabinet, or other?
- Require providers to educate patients regarding the risks associated with highly addictive substances and how to safely dispose of their medication prior to prescribing opioids.
- Review access to telemedicine services in rural communities and other medically underserved areas to address coverage gaps and limited access to transportation to urban communities with treatment services and facilities.
- Ensure the Statewide Behavioral Health Coordinating Council remains intact and continues to coordinate and financially align the programs among the various state agencies and entities to address substance use disorders and abuse.
- Address the state’s lack of facilities and capacity for treatment options by creating matching grant programs, and promoting partnerships between state agencies and treatment facilities; allow for local flexibility over funds granted to treatment providers with state contracts.
- Promote regional accountability for public sector SUD outcomes.
- Continue review of federal and other states’ programs and initiatives regarding the opioids and substance abuse crisis to help develop plans of action to assist Texans in avoiding use of these drugs or getting treatment to break the cycle of addiction, and to fulfill one’s potential to live, work, and support a family. Ensure the state is applying for available funds from the various federal programs. Formulate a plan for the infusion of federal dollars, aligned with state priorities.
Public Hearing 2: Charge 1 – Overview of Opioids and Substance Abuse, Charge 2 – Substance Abuse in Specified Populations, Charge 3 – Review of State Agency Policies/Guidelines, Charge 6 – Impact on Child Protective Services
- Increase awareness of the dangers of opioid use during pregnancy and distribute educational materials to women in the Medicaid for Pregnant Women Program.
- Review housing programs and consider a funding mechanism to improve substance abuse treatment capacity and recovery housing initiatives for mothers and their children, veterans, the homeless, and those with mental illnesses.
- Encourage programs through the Texas Veterans + Family Alliance (TV + FA) grant program.
- Consider request that HHSC study and advise numbers served, costs impact, and potential benefits regarding Medicaid reimbursements to recovery community organizations (RCOs).
- Require Medicaid MCOs to report to HHSC on the success of programs they have implemented and report on barriers encountered and how the barriers are being addressed.
- Consider allowance of Medicaid MCOs to implement safety edits when prescribing opioids and other highly addictive substances to patients and require a report to HHSC.
- Consider requiring high risk Medicaid patients be locked into one pharmacy and doctor.
- Consider flexibility in the Medicaid program to implement safety prior authorizations.
- Require an automatic manual review by MCOs of patients receiving more than a seven day, or CDC guidelines, script of opioids and other highly addictive substances.
- Continue tight management programs within employer plans.
- Encourage continued meetings between the state-administered insurance plans for discussion of trends and sharing of ideas on efficiencies of programs.
- Increase overall use of electronic medical records and sharing of patient data among treating physicians.
Public Hearing 3: Charge 4 – Review of Prescribing Practices and Implementation of the Prescription Monitoring Program
- Ensure the requirement for prescribers and dispensers to check the Prescription Monitoring Program (PMP) prior to prescribing or dispensing is implemented September 1, 2019 (as passed in House Bill 2561 (85R)).
- Review the cost of integration of PMP for the various prescribers and dispensers and determine if the state should pay for the integrated user fees or if individual users should be responsible for the fee.
- Require out-of-state pharmacies to report to the Texas PMP program if they dispense controlled substances to patients living in Texas.
- Establish legal penalties for wrongful use of PMP data.
- Allow receipt of PMP data by patient, parent, or guardian on behalf of minor child and health-care agent, attorney or third party with consent.
- Require enhancement of prescriber education regarding opioids and evidence-based pain management; include collaboration with institutions of higher education and hospitals for maximum patient safety and prevention of addiction and to examine the full range of therapeutic options for the treatment of pain.
- Require education regarding the addiction potential of opioids during CME and student education for all medical professions.
- Review creating a program to proactively contact patients who have been identified via the prescription monitoring program (PMP) or otherwise, as a “doctor shopper,” and make an attempt of placement in a treatment facility or initial MAT evaluation. Additionally, when a physician is arrested for inappropriate prescribing, provide outreach to the physicians’ patients with options for drug treatment.
- Ensure prescribers have the necessary training and tools to know how to respond when they find evidence that their patients are “doctor shopping.”
- Require e-prescribing.
- At point of sale, require that clients receive a notice indicating the potential and likely dangers of opioid use and the legal consequences for inappropriate diversion of opioid products.
- Continue efforts authorized in Senate Bill 1462 (84R) to ensure that people who need access to an opioid antagonist are identified and properly trained in how to use these lifesaving drugs; consider establishing a standing order for naloxone through DSHS.
- Encourage businesses/agencies to keep overdose prevention drugs on hand in the case of an emergency.
- Continue to promote compatibility of Health Information Exchange (HIE) systems for data sharing among the varied care providers.
- If an opioid is dispensed, consider including an overdose prevention drug with the original prescription as a safety measure.
- When prescribing/dispensing addictive drugs, implement an education resource that more actively involves the consumer who receives the prescription (like an interactive video link).
- Consider including overdose prevention drugs in first aid kits.
Public Hearing 4: Charge 5 – Impact on Scope of Work for Law Enforcement, Charge 7 – Review of ‘Good Samaritan” Laws
- Consider options for funding and equipping first responders, schools, and possible households with a naloxone product.
- Review for increased funding for law enforcement to divert low level criminal offenders to substance abuse treatment.
- Report additional details in substance-specific criminal offenses, including more specific data for activity in jurisdictions and regions across the state, for better identification of “hot spots” of specific substance crises for more direct substance-specific resources to combat, treat and prevent substance related problems.
- Create a statewide data system to break down case level data including the type of drugs involved in drug cases.
- Evaluate merit of statewide collection of toxicology reports of adults and juveniles.
- Make as state policy regarding law enforcement that handling and field testing of powdered substances shall require law enforcement agencies to adopt best practices to ensure the safety of their officers who may have direct contact with these substances.
- Enhance punishment levels in criminal statutes for the use, possession, manufacturing and/or distribution of fentanyl due to the serious and obvious dangers surrounding the substance.
- Generate a public awareness initiative highlighting protections available for “Good Samaritans.”
- Enact “Good Samaritan” legislation to provide basic legal protection for those who assist a person who is injured or in danger (ensure stipulations regarding drug dealers, certain amounts of drugs, etc.).
- Consider implementing a pilot program that would allow public health professionals to track individuals who have received naloxone.
- Consider harm reduction efforts related to public health.
- Increase awareness among communities regarding safe needle disposal practice and associated resources available to patients.
- Consider pros and cons of counties’ and municipalities’ abilities to fund syringe exchange services programs and similar harm reduction initiatives.
- Consider creating a program for sharing of information among providers, first responders, and law enforcement, to locate and treat victims, and to increase the identification and prosecution of the suppliers.
- Develop a universal substance use screening tool and supplement SBIRT.
Public Hearing 5: Charge 6 – Impact on Texans Involved in Criminal Justice System and/or Child Protective Services, Charge 8 – Review of Specialty Courts
- Leverage the opportunities for funds from the federal Family First Prevention Services Act.
- Review expanding treatment which focuses on trauma and adverse childhood experiences (ACEs).
- Ensure children of drug abusers and other at-risk children have access to psychological counseling and education regarding drug abuse.
- Support the expansion of specialty drug courts.
- Review creating a family counseling program for families who have successfully completed Family Drug Treatment Courts (FDTC) programs focused on maintaining sobriety, rebuilding the family unit, and other family therapy services.
- Review creating a statewide data system to track people involved in the specialty drug court system.
- Explore an increase for funds and accessibility for substance abuse treatment programs in prison.
- Study funding mechanisms for alternatives to incarceration diversion and pretrial diversion and treatment providers.
- Review resources for therapeutic foster care services for youth in foster care with severe mental, emotional, or behavioral health needs.
- Allow collection of data on all drug offense drugs for a record of the prevalence of substances being abused in the state.
- Consider establishing a statewide Opioid Task Force.
- Review means for collection of relevant case level data from all court levels.
- Consider amending Title 2, Subtitle K of the Government Code to provide the Judicial Branch increased oversight of specialty courts.
- Consider funds to the Office of Court Administration for the development of a statewide specialty court case management system.