1. Colorado Opioid Task Force
Jeff Lalama, Pharm D, BCPS
Gina Moore, Pharm D, MBA

2. Program Outline Introduction/Background Bills summary Bill A Bill B
Overview of the remaining bills
Wrap-up/Questions

3. Introduction/Background
Approximately 17,000 people die each year in the US from opioid overdoses
300 deaths in Colorado
“One of the four most serious epidemics facing the nation” per the CDC
Colorado was #2 in the nation in for non-medical uses of prescription painkillers (#15 in 2017)
83% increase in Colorado newborns addicted to opioids
Heroin use in Colorado has also risen dramatically

4. Colorado opioid-related deaths
Frank, J. Colorado’s opioid epidemic explained in 10 graphics. The Denver Post, 11/6/2017

5. Opioid and Other Substance Use Disorders Interim Study Committee
Interim task force convened by the Colorado legislature
Bipartisan representation
Met several times over the summer
CPS represented by Jeff Lalama and Gina Moore, who provided formal testimony
Six bills came out of the interim committee to be introduced in the upcoming legislative session

6. Bill Topics Bill A – Prevention of opioid misuse
Bill B – Clinical practice measures for safer opioid prescribing
Bill C – Measures to address opioid crisis in Colorado
Bill D – Expand access to behavioral health providers
Bill E – Medicaid inpatient and residential substance use disorder treatment
Bill F – Payment issues relating to substance use disorder treatment

7. Bill A – Prevention of Opioid Misuse
Section 1 – Creates opioid and substance use disorder study committee
Section 2 – School-based health center grant program
Section 3 – Grants for organizations dealing with substance abuse
Section 4 – Continuing education programming for pain control and opioid use

8. Opioid and Substance Abuse Study Committee
Committee responsibilities
Study data and statistics on scope of substance abuse disorders in Colorado
Study resources available to Coloradans for prevention, treatment, and recovery
Review availability of medication-assisted treatment and if pharmacists can help through collaborative practice agreement
Examine other states and countries to determine best practices for treating substance use disorders and prescription drug monitoring
Identify gaps and hurdles for resources available to Colorado
Identify legislative options to address gaps and hurdles identified

9. Opioid and Substance Abuse Study Committee
Bipartisan committee comprised of 5 members from both the senate and house of representatives
May meet up to 6 times per calendar year
May introduce up to 6 bills for the 2019 and 2020 legislative sessions
Committee will be repealed on July 1, 2020

10. Continuing Education
Center for research into substance use disorder prevention, treatment, and recovery shall develop continuing education activities:
Help prescribers safely and effectively manage pain, prescribe opioids or medication assisted treatment when appropriate
Training for law enforcement and first responders for using opioid antagonists to treat overdoses
Community-based training for people at risk of opioid overdose
Center will be appropriated $750k from the marijuana cash fund to develop these activities
Section will be repealed on September 1, 2019

11. Opioid Bill B – Quantity Limits
The bill restricts the number of opioid pills that a health care practitioner, including physicians, physician assistants, advanced practice nurses, dentists, optometrists, podiatrists, and veterinarians, may prescribe for an initial prescription to a 7-day supply and one refill for a 7-day supply, with certain exceptions.

12. Opioid Bill B – Quantity Limits CPS Survey Results

13. Opioid Bill B – Quantity Limits
Current exceptions to the 7-day supply
“past the time of normal healing”
“is the result of an underlying medical condition, disease, injury, medical treatment, or inflammation, or an unknown cause, any one of which may become progressively worse or recur intermittently”
“cancer-related pain”
“experiencing post-surgical pain expected to last more than 14-days”
“is prescribed a drug with an added abuse-deterrent”

14. Opioid Bill B – Quantity Limits CPS Survey Results

15. Opioid Bill B – PDMP Requirements
Current law allows health care practitioners and other individuals to query the prescription drug monitoring program (program). The bill requires health care practitioners to query the program before prescribing the first refill prescription for an opioid except under specified circumstances, and requires the practitioner to indicate his or her specialty or practice area upon the initial query

16. Opioid Bill B – PDMP Requirements
Current law allows health care practitioners and other individuals to query the prescription drug monitoring program (program). The bill requires health care practitioners to query the program before prescribing the first refill prescription for an opioid except under specified circumstances, and requires the practitioner to indicate his or her specialty or practice area upon the initial query

17. PDMP Integration and Provider Report Cards CPS Survey Results

18. PDMP Integration and Provider Report Cards
CDPHE tasked with reporting out data from “Prescription Drug Overdose Prevention for States Cooperative Agreement” previously received federal grant
Due on or before September 1, 2019
Data includes:
PDMP Integration methods
Provider report cards
Center for Research Into Substance Abuse Disorder Prevention, Treatment, and Recover Support Strategies to use data to develop voluntary training

19. Bill C – Measures to Address Opioid Crisis in Colorado
Designates hospitals may be used as a clean syringe exchange site
Civil immunity for participants of clean syringe exchange programs
Supervised injection facility pilot program in the city and county of Denver
Allows schools to obtain opioid antagonists and train employees on administration for someone at risk of experiencing a drug overdose
Requires commission on criminal and juvenile justice to study sentencing related to opioid-related offenses

20. Bill D – Expand Access to Behavioral Health Providers
Colorado Health Service Corp program modifications:
Allows primary care office to develop and administer state health professional shortage areas
Allows behavioral health care providers loan repayment programs on condition of providing care in health professional shortage areas for a specified period
Advisory council to prioritize loan repayment and scholarships
Establishes a scholarship program
Adds 2 members to the council to review program applicants
Appropriates $2.5 million from marijuana cash fund annually to provide loan repayments and scholarships

21. Bill E – Medicaid Inpatient and Residential Substance Use Disorder Treatment
Adds residential and inpatient substance use disorder services to the Colorado medication assistance program
Benefit limited to patients meeting criteria for residential and inpatient substance use disorder treatment
Benefit will not become effective until federal authorizations and federal financial participation in the program are obtained

22. Bill F – Payment Issues Relating to Substance Use Disorder Treatment
Requires all health benefit plans to provide coverage without a prior authorization for a 5-day supply of buprenorphine for first request within a 12-month period
Physical therapy, acupuncture, or chiropractic services shall not be given less favorable coverage than primary care services if the patient has a diagnosis of chronic pain or substance use disorder
Patient satisfaction surveys with pain treatment cannot solely be used by a carrier to take adverse actions or financial incentives/disincentives to a provider
Permits a pharmacist entering a collaborative practice agreement to administer injectable medication-assisted treatment for substance abuse disorders and receive an enhanced dispensing fee

23. Bill F – Payment Issues Relating to Substance Use Disorder Treatment
Prohibits step therapy by using an opioid before covering a non-opioid
Requires Colorado medical assistance program to authorize reimbursement for a ready-to-use intranasal version of naloxone without prior authorization
Requires establishment of rules standardizing utilization management authority timelines for non-pharmaceutical components of medication-assisted treatment for substance use disorders

24. Future Advocacy
Committee will be active for another 2 years (if Bill A passes)
Continuing education not currently mandatory
Many moving pieces, depends on version of bills that ultimately get passed

25. Questions? ?