Senate File 46, your heart is in the right place

by Wyoming Liberty Group Staff

According to the Wyoming Department of Health, 67% of drug-related deaths in Wyoming occurred because of prescription drug overdoses. The Centers for Disease Control and Prevention (CDC) estimates that in 2017, 49,000 Americans died from opioid overdoses, with overall overdoses up 10% from the previous year. Fentanyl (an extremely potent opioid) was responsible for more than 29,000 deaths alone.

How did we get here, and how do patients fall victim to opioid addiction? There are two stages that some users can experience in a short period of time. The first is opioid dependency, which occurs when a patient feels unable to function normally without the drug. The second, much more dangerous stage, is opioid addiction.

This can take the form of a debilitating disease that severely impacts the patients' ability to function in normal society, and can often lead to overdose or death. It should be noted that America is currently in the middle of an opioid epidemic, as you will observe in the graph below.

Source: https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates

Opiates are defined as narcotic pain relievers that contain either natural or synthetic opium, the same substance that plagued one of the most powerful Chinese dynasties for two hundred years. If you would like to jump down that rabbit hole and read more about the opioid crisis in 18th century China, please click here.

The graph demonstrates the crisis we find ourselves in. Mind you, methamphetamine continues to be a significant problem in Wyoming, and yet it is responsible for less than half of the deaths that opioids are.

As a nation we averaged 200 overdose deaths per day in 2017. Now consider that in 2015, during the height of the opioid epidemic, doctors in Wyoming were prescribing an average of 65.3 opioids per 100 people, totaling in 383,000 prescriptions for the full year.

The Wyoming legislature has taken it upon themselves to address the problem at the source: over-prescribing opioids in scenarios where the patient is experiencing acute pain.

Last week, the Senate passed a bill that would limit the number of pills prescribed to "opiate-naïve" patients, Senate File 46, Opioid Prescription Limits. Lawmakers here define the term "opiate naïve" as someone who has not taken prescription opiates in the previous 45 days. While this aim is good, it fails to address the fact that someone who is not opioid naïve is exempt from the bill, which inadvertently makes them opiate-versed.

On the surface, this bill makes sense because it's combatting the plague of addiction at its source. If you cannot get more than a certain number of pills, it then creates a significant barrier to addiction. Upon closer inspection you will find that this bill fails to attack the epidemic in the right manner.

The reason to not support this bill? According to the Mayo Clinic, "opioids are safest when used for three or fewer days to manage acute pain, such as pain that follows surgery or a bone fracture."

What they are saying is that the average person can become dependent on pain medication within 3 days, not the 14 days specified in the bill. That being said, I am willing to make an exception for people who may be suffering from acute pain for a week at a time, hence my recommended 7 day period.

The whole point of the bill is to avoid the possibility of opioid tolerance, dependence, and eventually addiction. In their monthly volume, The University of Florida Drugs and Therapy Bulletin stipulates, "Opioid tolerance is associated with taking opioids routinely for 1 week or longer."

The same article differentiates between opioid naïve and tolerant patients by saying, "Opioid naïve implies patients are not chronically receiving opioids on a daily basis. "'Opioid tolerant' implies patients are chronically receiving opioids on a daily basis."

So the question is, if the University of Florida Medical School and the Mayo Clinic haven't defined opioid naïve patients, why would the Wyoming state legislature attempt it?

Of course, the length of time it takes for a patient to become opiate-dependent can vary based on the person's height, weight, and tolerance for opiates from past experiences. This is where we need to address the "opiate-naïve" portion of the bill. One of the ways lawmakers aim to accomplish their goal is by classifying people who are "opiate-naïve" as someone who has not taken opioids in the previous 45 days.

Is it really a good idea to only limit the amount of pills that can be prescribed for an opiate naïve person, while neglecting the possible dependency of those who have experience taking opioids? If this bill were to pass, then someone who has taken opioids within the previous 45 day period would be exempt from the 14 day supply restriction.

Does this really make sense when we are trying to limit the amount of pills a patient can take? My answer can be found in the following amendment to Senate File 46:

(e) No practitioner shall prescribe nor shall any person dispense any opioid or combination of opioids for acute pain to an opioid naive patient for more than a fourteen (14) seven (7) day supply in a fourteen (14) seven (7)day period.

As you may have guessed, I would also support an amendment that strikes the definition of opioid naïve individuals from the bill. Instead, I would endorse the Wyoming government regulating the prescription of opioids across all patient demographics, regardless of their previous experience with opioids.

To demonstrate this point, think back to when you had your wisdom teeth out. Odds are you were prescribed a large bottle of oxycontin or hydrocodone. Ask yourself if you used the entire bottle of pills, or if you were able to save some of for future surgeries.

Now consider a scenario where you were not under adult supervision and had the opportunity to take as many pills as your heart desired, and you can see how some people can become dependent on pain medication.

The legislature's goal with this bill is to prevent you from becoming dependent (or addicted) because you were prescribed a numerous pills instead of enough to cover a week at a time. After all, I only needed a few days worth of pills to get through a painful week of recovery after all four of my wisdom teeth were removed.

If you know someone in your family or friend group who became dependent on opioid medication, then you have first-hand knowledge of how addictive and destructive these medications can be.

I am confident that if the Labor and Health Committee made my recommended changes to Senate File 46, then we could better protect patients from the hazardous potential that opioids have already demonstrated across the country. Keep in mind that since 1999, the CDC estimates that more than 400,000 Americans have lost their lives to opioid overdoses. The sad reality is that almost every death was preventable.

If you would like to reach out to your elected official to let them know that you are concerned about opioids, feel free to contact them by following the link below:

Labor, Health & Social Services Committee roster: https://www.wyoleg.gov/Committees/2019/J10

To contact your representative, please click on the individuals' name and then click the "contact me" section to find their information.