Ohio’s fight against heroin addiction

 Cincinnati.com last week had two closely related articles about Ohio’s fight against heroin addiction, “prescription drug and heroin overdose having skyrocketed in Ohio,” as one reported, with Ohio’s drug overdose death rate increasing 440 percent from 1999 to 2011,  according to the Ohio Department of Health, until about five Ohioans were dying of drug overdoses every day.”

  The first article centered around Warren County Judge Robert Peeler – “in a first for local criminal justice systems and a move that’s being studied at several prisons and jails across the country -- ordering a defendant to undergo a series of nine to 12 injections of Vivitrol, the non-narcotic drug naltrexone that blocks the brain’s ability to get high on opiates, including heroin, or drunk on alcohol, with his receiving the first shot while still in jail.

  That article said the drug (naltrex) was approved by the Federal Drug Administration in injectable form in 2010, and found to help addicts keep from relapsing, but that the risk of relapse among individuals with opioid addiction was extremely high – up to 90 percent over the course of a year without what is called medication assisted therapy. The article also related that a 2011 pilot program that provided Warren County inmates with Vivitrol injections had a 25 percent success rate, better than the 10 percent outcome for traditional treatment, which includes abstinence and counseling.

  The second article centered around HB 170, introduced by Representatives Terry Johnson & Michael Stinziano in May. Where the first instance centers around Naltrexone, marketed as Vivitrol, and used in drug dependency programs, HB 170 focus is a drug called Naloxone, employed in cases of opioid-related overdoses. One of its prominent provisions encompasses “ granting immunity from criminal prosecution for the unauthorized practice of medicine,  drug offenses, or administrative action to licensed emergency responders and police officers obtaining naloxone from the licensed emergency responder's emergency medical service organization or law enforcement agency (which must be licensed as a terminal distributor of dangerous drugs). It passed the House’s Health and Aging Committee on Sept. 25 in substitute form.

  SB 105, meanwhile, introduced in April, concerns “specifying what constitutes the training necessary for an individual who is not authorized by the Revised Code to administer naloxone to safely and properly administer that drug to another individual by the intranasal route of administration, and  certify each individual successfully completing intranasal naloxone administration training.”  Its first hearing before the Senate’s Medicaid, Health and Human Services Committee was June 12th..

  Lastly is Senate Bill 57 which in essence does all the above, including:

• Establishing a pilot project in Lorain County whereby qualified emergency responders who serve in that county may obtain and administer naloxone to a person suffering from an apparent opioid-related overdose in order to revive the person, said pilot program lasting for one year, beginning November 1, 2013.

• Requiring the Lorain County Coroner to provide, or to designate one or more licensed health professionals or registered nurses to provide, training to emergency responders in recognizing and responding to an opioid overdose and to provide  emergency responders who satisfactorily complete the training a letter indicating that completion, thereafter  establishing civil immunity under specified circumstances for a licensed health professional, qualified emergency responder, emergency medical service organization, law enforcement agency, firefighting agency, or registered nurse who participates in the pilot program, and

• Requiring the Lorain County Narcan Task Force and the Ohio Department of Health each to conduct a separate study of the effectiveness of the pilot project and each to prepare a separate report of findings and certain recommendations; the Task Force and the Department each to send a copy of the report to the Governor, the President and Minority Leader of the Senate, the Speaker and Minority Leader of the House, and the Director Mental Health and Addiction Services

   Senate Bill 57 was passed June 27th., signed by Gov. Kasich on July 11th., and --- coincidentally --- also becomes effective this Friday, October 11th.

   Maintaining an interesting sense of timing here, Cincinnati.com this afternooon reports “Gov. Kasich’s introducing new guidelines for prescribers of high-powered opioid pain medication for patients with chronic, non-terminal pain in an attempt to reverse a crisis of opioid abuse and overdose in the state,  recommending that 80 milligrams Morphine Equivalent Daily Dose (MED) should trigger the prescriber to “press pause” and reevaluate the effectiveness and safety of the patient’s pain management plan,  according toseveral state health officials.”