A House committee has approved seven bills aimed at fighting the opioid crisis in Virginia. The legislation would limit the prescription of medications containing opioids, establish guidelines for the use of opioids to treat pain and make opioid overdose reversal drugs more easily available.
The House Health, Welfare and Institutions Committee voted unanimously Thursday in favor of the proposals and sent them to the full House of Delegates for consideration.
On an average day, three Virginians die of a drug overdose, according to State Health Commissioner Marissa Levine. In November, she and Gov. Terry McAuliffe declared the opioid crisis a public health emergency.
"It's been an epidemic for us for years," said Honesty Liller, CEO of the McShin Foundation, a Richmond-based addiction recovery organization. "About 85 percent of our people in our program are opioid addicts. So it's definitely real, it's definitely on the rise and it's definitely getting bigger."
The House bills moving through the legislative process include:
•HB 1885, prohibiting doctors from prescribing more than a seven-day supply of controlled substances containing opioids. Exceptions would be made for cancer and chronic pain patients.
•HB 2165, requiring electronic prescriptions for drugs containing opioids, an effort to crack down on prescription fraud.
•HB 1750, allowing pharmacists to dispense naloxone, an opioid overdose antidote, to patients who don't have a prescription.
•HB 2167, requiring the boards regulating doctors and dentists to adopt rules for prescribing opioids and products containing buprenorphine, a drug used by addicts to suppress withdrawal symptoms.
Liller supports bills like HB 2167 because she says drugs containing opioids are overprescribed. She knows that from firsthand experience.
Liller is a recovering opioid addict. During the early stages of her recovery, she said, a doctor prescribed her drugs containing opioids – even after she explained that she was an addict.
If HB 2167 became law, it would limit the dosages and length of time a doctor can prescribe opioids to their patients. It also would require doctors to review their patients' treatment history using the Prescription Monitoring Program, a database created to deter illegitimate use of prescription drugs.
Moreover, under the bill, doctors who prescribe buprenorphine for the treatment of addiction would have to refer such patients to substance abuse counseling. Buprenorphine is a "partial agonist opioid," meaning that it activates the opioid receptors in the brain — but to a much lesser degree than heroin, oxycodone or morphine.
The House committee also approved HB 2161, which would create a workgroup to establish educational guidelines for training health care providers in the safe prescribing and appropriate use of opioids, and HB 2163, which says all buprenorphine prescriptions must include a prescription for naloxone.
"The naloxone is just a reviver, so it knocks the opioid receptors off your brain while you're overdosing. But the buprenorphine is a completely different drug that is to make you feel comfortable through your detox," Liller said.
When declaring the opioid public health crisis last year, Levine announced a standing order permitting all Virginians to have access to naloxone. HB 1750 would make that order a state law by allowing pharmacists to dispense naloxone without a patient-specific prescription.
Currently, pharmacists and emergency workers like police officers are the only people authorized to dispense naloxone in Virginia. One of the bills sent to the House floor would expand the availability of the drug beyond medical professionals.
HB 1453 would affect people who have taken training from the state Department of Behavioral Health and Human Developmental Services on how to teach others to administer naloxone. The bill would authorize the trainees to show others how to administer naloxone and to dispense the life-saving drug to the people they teach. Right now, people who complete the behavioral health agency's training don't have the authority to dispense naloxone.
Del. Dave LaRock, R-Loudoun, introduced the bill when Winchester County, which borders his House district, became an opioid hotspot. He said he is confident the bill will pass the House and eventually become law.
"I would give it somewhere north of 99.9 percent," LaRock said. "Because the drug (naloxone) is so safe and because the need is so severe, it (the bill) actually has an emergency enactment clause on it which requires it have a two-thirds vote instead of a simple majority. And I'm confident that it'll pass with that two-thirds majority."
Most of the House bills have companion legislation in the Senate. Three of the companion bills already have received unanimous approval in the upper chamber.