New Laws in Georgia to Combat the Opioid Crisis

While the opioid crisis continues to be an issue nationwide, it is particularly ravaging the state of Georgia. The state has seen a rapid growth of opioid overdoses and overdose deaths in recent years and appears to be taking steps to be a leader in the fight against street forms of opioids that might be causing the rash of overdoses and deaths.

Lawmakers have been attempting to curb the epidemic by enacting legislation against specific forms of opioids as well as placing limitations on prescriptions. Certain bills, however, have not passed, for better or worse, while others may be problematic. We’ll take a look at several in this post and examine further legislation proposed by the Substance Abuse Research Alliance (SARA).

Laws and Public Safety Warnings for Furanylfentanyl and U-47700

U-47700 (commonly known as U-4) and furanyl fentanyl are substances that have been found in recent deadly batches of opioids in Georgia. In response, the Georgia General Assembly passed legislation to ban both U-4 and furanyl fentanyl. Governor Nathan Deal signed the bill into law, and it went into effect on April 17.

Local authorities have also taken notice of Georgia’s struggles with deadly batches of opioids in recent months and issued warnings to citizens. A public safety alert was released by the Georgia Bureau of Investigation after 17 deaths were caused by furanyl fentanyl and U-47700 in the span of four months–the same number of fatalities attributed to the drugs in all of the prior years.

Furanylfentanyl is a synthetic opioid that comes in liquid or powder forms. According to authorities, they are often used to lace other opiates, including heroin, because they are actually cheaper than heroin despite their potency.

In most of the  50 cases involving furanyl fentanyl or U-47700 (often called just U-4) reported by the GBI Crime Lab this year, the drugs were mixed with three or four additional opiates.

A legal form of fentanyl is occasionally prescribed medically in cases of extreme pain management, but furanyl fentanyl is an illegal chemical offshoot of the drug. Furanyl fentanyl and U-4 can both be deadly in very low doses. According to the DEA, just two milligrams of fentanyl is a deadly dose for most people. Each or the drugs can be toxic in quantities as small as a couple grains of sand and can be absorbed through the skin or inhaled. Both fentanyl and U-4 were found in the system of legendary entertainer Prince when he died.

Each drug causes similar symptoms, such as shallow breathing, pinpoint pupils, nausea or vomiting, dizziness, lethargy, cold or clammy skin, loss of consciousness and/or heart failure. If you suspect someone has come in contact with these drugs or overdose, Naloxone should be administered if it is available, and multiple doses may be required. And of course, call 911 immediately.

Bill To Limit Opioid Prescriptions Vetoed By Governor Deal

One bill that was actually vetoed by Governor Nathan Deal was SB 125. This bill would have given physician assistants the right to independently prescribe hydrocodone.

While creators of the bill certainly had good intentions, they didn’t realize the backlash they would receive from the ADHD community. A provision in the bill would require adults and children on medication for ADHD to get new prescriptions every five days, which would have created a difficult to an impossible situation for those families. Patients would also need to be re-entered into the database every 90 days.

Shortly after word of the bill spread on social media, doctors and state health leaders and politicians began receiving phone calls and emails from people with questions about the bill (SB 81).

The bill did have some positive provisions, however. Meant to curb the abuse of highly addictive prescription opioid painkillers like OxyContin and Vicodin, SB 81 would have allowed for opioid blocked Naloxone to be sold over the counter. This medicine is used by emergency responders in the instance of an overdose and can often be a lifesaver. Allowing for sale over the counter would let people who know they have an addict or drug abuser, or recovered addict or abuser in their family have Naloxone on hand and be able to use it if their loved one has an overdose or relapse. Proper training to administer Naloxone would have also been required.

SB 81 also would have allowed doctors to see if a patient had recently received an opioid prescription from another doctor. This would help prevent doctor shopping–a common behavior of drug addicts in which the addict goes to different doctors to attain more opioids undetected. This is a dangerous behavior that could set a person on the path toward an overdose as their tolerance and dependency increases.

However, the controversy surrounding the provision that would limit a doctor’s ability to write prescriptions for controlled substances to just five days was too much to overcome. Adderall, Ritalin, and Vyvanse are all used to treat ADHD but would have fallen under these limitations. There was no exclusion laid out in the bill for people who have ADHD.

The bill also would have limited prescriptions of medications that are used to treat seizures, among other conditions. Many patients have been dependent on these medications for years and already have strict regulations to get refills.

The bill may yet become a reality with some modifications, but a new bill has yet to be seen.

Also Vetoed: Bill Allowing Physician Assistants to Independently Prescribe Hydrocodone

Bill SB 125 was also sent packing after strong opposition from The Georgia Chapter of the American Academy of Pediatrics. This bill more specifically targeted hydrocodone, which is a dangerous opioid used to treat pain relief in children, adolescents, and adults. It is also commonly abused, highly addictive and a large part of Georgia’s opioid epidemic.

Like SB 81, SB 125 also limited prescriptions to a five day supply, and also had dosage limitations of no more than 300 milligrams (30 tablets) for adults and no more than 100 milligrams (30 pills) for patients under 18 years old. Opposition to this bill was in the other direction, saying that these limitations were not enough.

Those in opposition argued that hydrocodone is the prescription opioid that is most commonly abused by adolescents. Those arguing to the contrary pointed toward hydrocodone being a necessary treatment for pain from broken bones, but there are alternatives to hydrocodone that don’t come with the high risk of abuse, including high doses of ibuprofen or acetaminophen.

The proposed bill would have allowed physician assistants to independently prescribe hydrocodone, but was denied because if a child has considerable pain, they should be seen and treated by a physician.

The manufacturers of hydrocodone actually acknowledge that it may not be safe for children and adolescents, with packaging stating that the drug’s “safety and effectiveness in pediatric patients has not been established.” This may be because adolescents process opioids differently than adults. Their rapid metabolisms allow the drug to decrease brain cells more than in adults, which can more rapidly reduce cognitive functioning and produce that euphoric feeling often associated with opioids.

SB 125 was targeted for rural communities in Georgia, but the Georgia Health News op-ed calls this “nonsense,” arguing that “the children of rural Georgia deserve and should have the same standard of care as the rest of our state.” Governor Deal mentioned in his veto message that with roughly 4,700 physician assistants licensed in Georgia, the number of additional hydrocodone prescriptions that the bill would allow during an opioid epidemic would be staggering, and far too much potential for further disaster to allow.

Moratorium to Limit Treatment Clinics Passes

In a less fortunate instance, Georgia placed a one-year moratorium on issuing licenses to clinics that use medicine to treat people addicted to heroin or painkillers. The moratorium went into effect June 1.

Outpatient clinics across the state administer legal synthetic opioids like methadone and buprenorphine that help addicts to block cravings and withdrawal symptoms. According to federal health officials, this medication, along with counseling, is the best way to treat an addiction to opioids–including prescription painkillers and heroin. Patients are required to show up at the clinic a set number of times a week depending on how long they have been receiving treatment and must take their medicine in front of a nurse.

With drug overdoses particularly related to opioids skyrocketing in Georgia in recent years, it hardly seems like the time to limit treatment options, but according to the bill’s sponsors, the freeze on new clinics is for just that reason–too many options.

Republican Senator Jeff Mullis sponsored the moratorium, saying the state needs to figure out why so many opioid treatment programs have opened in Georgia.

“If you go to the parking lot of any of these clinics in northwest Georgia,” Mullis said, “you’ll see as many Tennessee, Alabama, North Carolina, Kentucky tags as you do Georgia tags.” People are driving in from all over the South, he says, to get treatment there.

As part of the law, a committee has been established to look into the question of why so many opioid treatment programs have opened in Georgia. And while Mullis’s observation certainly highlights how widespread the opioid epidemic is becoming in the southeast, part of the problem might be a shortage of coverage in neighboring states, not that Georgia has too many. Some states have long wait lists to receive treatment. Rather than wait, many people head into Georgia to receive the treatment they so badly need.

Georgia currently has 67 opioid treatment programs, which is indeed more than any other Southeastern state. Only Florida comes close to Georgia, with 65, but Florida has nearly double the population of the Peach State. Neighbor-to-the-north Tennessee has just 12 clinics while Alabama has 24. Mississippi has just one.

Part of the problem, according to Mullis, is that Georgia makes it too easy to open a clinic. Georgia does have multiple licensing requirements to open a clinic, but forgoes a certificate of need program for narcotic treatment centers, which limits entry or expansion without proof of a need for it. In Georgia, it comes down to open competition.

Another issue with the moratorium is that part of the motivation behind it is the misled argument that the drugs being dispensed at these treatment centers are opioids themselves. Some argue that drugs like methadone just replace one addiction with another.

While some in recovery are able to taper off of the drugs and stay off for the rest of their lives, others may need to stay on them. There is a difference, however, with staying on medication versus having an addiction. A person can be dependent on treatment without being addicted to it. A further argument here includes the fact that opioids have severe withdrawal symptoms. Quitting cold turkey is incredibly unsafe, and can even be fatal.

A silver lining may be in the fact that there is not enough staff in the Georgia Department of Community Health to properly regulate the clinics. As of a June 15 story on this topic by Georgia’s NPR affiliate, WABE, the Department of Community Health only had three workers, with one more in training, to regulate Georgia’s 67 clinics. According to the same story, an agency spokesman said its rules and regulations also do not specify how frequently treatment centers should be inspected. Re-licensure surveys are conducted every two years.

State legislature has until May 31, 2017 to figure out how to best regulate the clinics, hopefully without taking away treatment options for those who badly need it.

Sources:

Hart, Ariel. “Controversy Flares Over Georgia Senate Bill to Curb Opioid Epidemic” AJC. 9 Feb. 2017. 28 Feb. 2019. https://www.ajc.com/news/state–regional-govt–politics/controversy-flares-over-georgia-senate-bill-curb-opioid-epidemic/1DnOJkpCglWQH0KKeua3JN/

Miller, Andy. “Georgia Senate Approves Bills on Opioid Epidemic, Health Council” Georgia Health News. 7 Feb. 2018. 28 Feb. 2019. http://www.georgiahealthnews.com/2018/02/senate-approves-bills-opioid-epidemic-health-council/

Magerman, Daniel. “How Georgia is Changing Its Treatment of Opioids” Willlingway. 16 June 2017. 28 Feb. 2019. https://willingway.com/how-georgia-is-changing-its-treatment-of-opioids/