Eden Laikin and Patrick McIntyre

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Pols Eye Opioid Crisis With Pending Legislation

The Drug Take Back Act, a new law taking effect January 6, aims to reduce opioid abuse, while at the same time prevent the contamination of our waterways.

The law requires large chain pharmacies to take back and properly dispose of unused and expired prescription medications for free. Studies show that up to 70 percent of teenagers who abuse prescription drugs get them from their parents’ medicine cabinets. The law would encourage proper disposal rather than flushing unwanted meds down the toilet into the water system.

“This initiative will improve both the environmental health and the physical health of all New York citizens,” said ex-state Sen. Kemp Hannon (R-Garden City), who proposed the legislation before losing his seat in November.

From 2010 to 2015, the number of deaths in New York State from drug overdose and chronic drug abuse increased by 71 percent. More Americans died from opioid addiction in 2016 than the total number of Americans who died during the entire Vietnam War. Nationally, there are roughly 2.5 million Americans addicted to opioids.

Several bills which contain tools to fight the opioid epidemic are expected to be reintroduced into the 2019 New York State legislative session.

One is the Senate’s version of the Medication-Assisted Treatment Bill, which would require the state’s 54 jails to provide substance abuse treatment to an overwhelming majority of inmates who are opiate-addicted. Jails would be mandated to offer addiction medications that curb opioid cravings such as injectable Vivitrol or daily doses of methadone, along with counseling and behavioral services. The bill was introduced in the state Assembly last November and in the Senate in June.

“Given that the state Legislature is likely to tackle issues relating to jail reform in 2019, I believe it will be an excellent opportunity to highlight the Medication-Assisted Treatment Bill,” says State Sen. Phil Boyle (R-Bay Shore).

Boyle said funding for the program has been included in the 2018-2019 state budget, with $200,000 each for Nassau and Suffolk jails. In all, the State Senate Task Force on Heroin and Opioid addiction secured $247 million in this year’s budget for related programs including hundreds more residential substance abuse treatment beds throughout the state.

Another package of bills was introduced by Assemb. Linda Rosenthal (D-Manhattan), who chairs the Assembly Committee on Alcoholism and Drug Abuse. One would establish a one-cent per milligram surcharge on opioid prescriptions to fund statewide drug addiction prevention, treatment, and recovery programs. Opioids for Medication Assisted Treatment, cancer and hospice care would be exempt.

Other Rosenthal bills, introduced between January and May, would require organizations to have Narcan (or Naloxone) — the antidote to a fatal opioid overdose — on site, and to have staff trained to administer the lifesaving medication. These include state offices with at least 10 employees, homeless shelters, and handlers of K9 detection dogs.

Another bill would require controlled substance prescribers to receive education regarding safe opioid prescribing. Most experts would agree that the current opioid epidemic was started from the over-prescription of addictive pain medication. This bill would amend the education law by requiring the state to create a curriculum to be offered in colleges or by providers approved by licensing boards by August 1, 2019 to include information on pain management, alternatives to opioid pain medications, identification of patients who are at risk for addiction, and training on managing substance use disorders as chronic diseases.

Senate Republicans also left some relevant bills pending. Those would limit the initial prescription of a controlled substance prescribed for acute pain from seven to three days, and require practitioners to obtain written parental consent before prescribing opioids to minors.

Finally, a bill sponsored by state Sen. Neil Breslin (D-Bethlehem) in January 2017, would increase the penalty for the sale of an opioid which leads to someone’s death to manslaughter in the first degree. The felony Class B carries a sentence of up to 25 years. Currently, the penalty for selling drugs varies from a Class A to a Class D felony sale, depending on the weight. There’s no additional penalty if the drug causes a death.

“While I strongly support an increase in criminal penalties on drug dealers who cause deaths by peddling their poisons in our communities, I think passage of this bill (manslaughter charge) is highly unlikely in a Senate and Assembly controlled by New York City-based Democrats,” says Boyle.

Medical Marijuana: The New Anti-Drug?

Medical marijuana is now approved to treat opioid addition.

Can medical marijuana help with the current opioid epidemic? Gov. Andrew Cuomo thinks so.

The potential link between marijuana and opioid addiction treatment is well documented. Multiple studies have indicated that for those struggling with chronic pain, marijuana could be a viable, nonaddictive alternative to opioids such as OxyContin, Vicodin or heroin. Medical marijuana has also been shown to help with the temporarily debilitating symptoms of opioid withdrawal — nausea, vomiting, spasms, cramps, and insomnia.

So, when New York State Health Commissioner Howard Zucker told the governor that medical marijuana offers a less harmful opioid replacement for recovery from opioid use disorder, Cuomo listened.

“In this battle against the opioid epidemic, it is critical that we use every means at our disposal to prevent the unnecessary prescription of these dangerous and addictive painkillers,” Cuomo said in a statement.

In September, the governor signed a bill that allows substance-use disorder treatment providers to recommend medical marijuana to treat pain instead of prescribing opioids. It also adds opiate-use disorder to the list of qualifying conditions for medical marijuana.

“Adding these conditions to the list of those approved for management with medical marijuana will help reduce the risk of addiction and provide suffering New Yorkers the relief they need,” Cuomo said.

Opioid abuse is the leading cause of lethal drug overdose nationwide. In 2015 alone, there were 20,101 deaths attributed to prescription painkillers, as well as 12,990 fatal heroin overdoses.

Nearly 80 percent of heroin users nationwide reported using prescription opioids before initiating heroin use.

In some states with medical marijuana laws, there has been a 24.8 percent drop in opioid overdose deaths. And each year after the medical cannabis law was passed, the rate of opioid overdose deaths continued to decrease, according to a report in the Journal of the American Medical Association.

At least 33 states, Guam, Puerto Rico, and Washington, D.C., have adopted medical marijuana programs.

“Medical marijuana has been shown to be an effective treatment for pain that may also reduce the chance of opioid dependence,” Zucker said. “Adding opioid replacement as a qualifying condition for medical marijuana offers providers another treatment option, which is a critical step in combating the deadly opioid epidemic affecting people across the state.”

Opioid replacement and addiction joins the following 12 qualifying conditions under the state’s Medical Marijuana Program: cancer; HIV infection or AIDS; amyotrophic lateral sclerosis (ALS); Parkinson’s disease; multiple sclerosis; spinal cord injury with spasticity; epilepsy; inflammatory bowel disease; neuropathy; Huntington’s disease; post-traumatic stress disorder; and chronic pain.

This new measure allows patients with severe pain to use medical marijuana as a replacement for opioids. It also allows patients with opioid use disorder who are enrolled in a certified treatment program to use medical marijuana as an opioid replacement.

To “recommend” medical marijuana to patients, practitioners — including doctors, nurse practitioners and physician assistants — must complete a state Department of Health approved course. They must also consult the New York State Prescription Monitoring Program Registry (PMP) prior to issuing a certification.

Patients who are certified by their practitioners must apply to the DOH for a registry identification card. Then, they may visit one of the state’s registered medical marijuana dispensaries.

Plans to add opioid replacement as a qualifying condition for medical marijuana in the state were first announced in June. They went into effect on a temporary basis in July and a 60-day public comment period began in August. As of November 13, there were 80,618 certified patients and 2,020 registered practitioners participating in the program.

In New York, medical marijuana is dispensed in several forms: capsule, liquid, vape, tablets, lozenges and ointments. The products contain varying levels of tetrahydrocannabinol (THC) — the psychoactive component of marijuana.

Dr. Stuart Wasser of Rockville Centre, a certified addiction specialist, says he’s skeptical.

“I believe it may reduce total amounts of opioids used, but I don’t think it will reduce absolute number of people using opioids,” he says. “In my experience, cannabis use leads to enough eіndorphin dysfunction that I would be concerned it would lead to opioid use. All we know is that experienced opioid users use less opioids when on THC, which is probably due to the [THC] having opioid-like properties.”