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Opioid bills would tackle Hawaii’s opioid crisis

A handful of bills to tackle the opioid problem in Hawaii are awaiting the governor’s signature to become law. One would give pharmacists the ability to prescribe medication that could save lives in case of a drug overdose.

But one regional health care group says it’s not waiting for a legal mandate. Kaiser Permanente says it’s staying ahead of the curve.

Opioid medications- most commonly seen as hydrocodone and oxycodone – are typically used for pain. They are, as the name suggests, an opium derivative.

The highly addictive medication is easily abused. The state legislature says opiod drug overdoses are one of the leading causes of death in Hawaii, with an additional 400 four non-fatal overdoses a year in this state.

Kaiser Permanente Hawaii region pharmacist Dr. Shelley Kikuchi explains, “They can be dangrous because if taken in doses too high, they can cause respiatory depression. You stop breathing. It shuts the body down.”

The legislature says opioid-related overdoses racked up about $9.8 million in hospital costs in 2016. It passed Senate Bill 2247 this session to allow pharmacists to prescribe medications to counteract an opioid overdose.

The bill relating to opioid antagonists is worded as authorizing “pharmacists to prescribe, dispense, and provide related education on opioid antagonists to individuals at risk of opioid overdose and to family members and caregivers of individuals at risk of opioid overdose without the need for a written, approved collaborative agreement; subject to certain conditions. ” The first committee draft passed and was enrolled to Governor David Ige on May 3, 2018.

“These are good life saving therapies where, if you’re going into an overdose or someone is overdosing, you can give them this nalaxone. It’s a reversal agent and it can save lives,” she says.

Kaiser Permanente already does this. “You wouldn’t have to go to your doctor and get a prescription at a pharmacy. You could just get it at the pharmacy,” says Dr. Kikuchi. She says Kaiser’s Hawaii region offers nalaxone, which blocks the effects of opioids.

One more thing Kaiser offers. This year, it started a free “Seal and Send” program for its patients. “You can put in any unused medication, seal, drop it in the mail, and off it goes. No postage required.

“We have a worldwide crisis opiod epidemic but I feel we do a darn good job of magaging patients on opiods, tapering them off, getting them to safer doses, and preventing new patients from escalating to that point,” says Dr. Kikuchi.

Dr. Kikuchi says safely discarding unused opioids – or any medications – is another way it’s trying to keep people healthy.

The Department of Health says it supports SB2247 and “applauds the collaborative efforts of the legislature and various state departments including the Board of Pharmacy, Department of Health, Department of Public Safety and other community stakeholders on this legislation. This measure is supportive of the goals and objectives of the Hawaii Opioid Initiative launched by Governor Ige last summer and is an example of the hard work that has occurred since then to reach those goals outlined in the plan and to address opioids in Hawaii.

“While many pharmacies have taken steps to support access to Naloxone, they have had to develop standing orders or cooperative agreements with prescribers in order to do so. This measure increases access by giving prescriptive authority for this life saving medication directly to pharmacists and allows them to play a key role in preventing overdose, educating the public on the dangers of opioid medications and linking those in need to treatment resources.

The DOH is working closely with the Board of Pharmacy, The Daniel K. Inouye College of Pharmacy, and the pharmacy community to prepare pharmacists who are willing to prescribe naloxone. There has been overwhelming positive response from the pharmacy community and we believe that at least 45-50% of Hawaii pharmacists would participate once the measure becomes law. We hope that within 4-6 months of the measure becoming law, pharmacies would be able to announce their participation.

In addition to the efforts related to this measure, the Department of Health continues to work with community providers such as CHOW and law enforcement entities across the state to make Naloxone available through federal funds received by the Department of Health’s Alcohol and Drug abuse Division. To date, our providers and partners have recorded 70 overdose reversals and have distributed 2200 doses of naloxone, including those provided to law enforcement.”

The other bills the Legislature passed relating to opioids this session are:
HB 1602
Requires the inclusion of a label warning of the risks of addiction and death on the packaging of any opioid drug dispensed by a health care professional or pharmacist.

SB 24507
Allows for the use of medical cannabis to treat opioid use.

SB 2244
Requires health care providers in the workers’ compensation system who are authorized to prescribe opioids to adopt and maintain policies for informed consent to opioid therapy in circumstances that carry elevated risk of dependency. Establishes limits for concurrent opioid and benzodiazepine prescriptions.

These bills are waiting for the governor to either sign them into law, let them become law without his signature, or for him to veto.



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