This article appeared in the May 2017 issue of the Georgia's Cities newspaper.
The opioid epidemic is a sobering and complex public health crisis that demands a communitywide approach. Almost every state has enacted legislation to combat this nonpartisan issue and to prevent drug overdoses from illicit and prescription substances. In 2014, the Georgia 911 Medical Amnesty Law was created by House Bill 966 to authorize law enforcement, first responders, EMS personnel and paramedics to carry and administer Naloxone, an opioid antagonist, pursuant to a licensed physician’s order. With this law in effect, the prevalence of first responders carrying naloxone varies depending on the funding available to purchase the naloxone kits in cities and counties in Georgia. Funding solutions should be explored by our counties and municipalities to ensure Naloxone is available to first responders and can be replenished after the kit passes an expiration date or is used in the field.
The synthetic opioids have played a key role in the crisis and reinforce the need for first responders to be equipped with adequate supplies. The synthetics are extremely potent especially in cases where heroin is combined with fentanyl or carfentanil.
On a state level, Georgia reached a pivotal point this past year when the Board of Pharmacy adopted Emergency Rule 480-34 0.31.11 to allow pharmacists to dispense Naloxone under a statewide standing order prescription, noting that “the steady and sharp increase in the number of overdoses and deaths due to prescription and illegal forms of opioid drugs poses an imminent threat to the public health, safety, and welfare.” The Georgia Legislature passed the “Jeffrey Dallas Gay, Jr. Act” (House Bill 249 and Senate Bill 121) to codify the Emergency Rule and increase access to life-saving naloxone this year.
House Bill 249 – “Jeffrey Dallas Gay, Jr. Act”
Sponsor: Rep. Kevin Tanner (R–Dawsonville)
- Permits certain persons to obtain Naloxone, a prescription-only opioid antagonist, pursuant to a statewide standing order imposed by the state health officer;
- Exempts Naloxone from the list of dangerous drugs when used for drug overdose prevention and when supplied by a dispenser in the form of certain nasal adaptor and muscle rescue kits or the prepackaged nasal spray and muscle rescue kits;
- Revises requirements for prescribers and dispensers regarding the utilization of the statewide electronic database known as the Prescription Drug Monitoring Program (PDMP), administered by the Georgia Drugs and Narcotics Agency (GDNA);
- Transfers the PDMP from GDNA to the Department of Public Health (DPH);
- Requires DPH to submit an annual report to the General
- Assembly on the information resulting from mandatory reporting of neonatal abstinence syndrome;
- Provides for the annual inspection and reporting of drug abuse treatment and education programs;
- Provides for notice to a county coroner or medical examiner in cases where an individual dies as a result of an apparent drug overdose; and
- Provides a short title to a section of current law that requires each local board of education that operates a school with grades nine through 12 to provide instruction in cardiopulmonary resuscitation and the use of an automated external defibrillator as part of existing health and physical education courses.
This bill requires prescribers to seek and review information from the PDMP when prescribing opioids, opiates, opiate derivatives or benzodiazepines to a patient for the first time and at least once every 90 days thereafter, unless:
- The prescription is for no more than a three-day supply and no more than 26 pills;
- The patient is in a hospital or health care facility, including but not limited to a nursing home, an intermediate care home, a personal care home or a hospice program, which provides patient care and prescriptions to be administered and used by a patient on the premises;
- The patient has had outpatient surgery at a hospital or ambulatory surgery center and the prescription is for no more than a ten-day supply of such substance and no more than 40 pills;
- The patient is terminally ill or under the supervised care of a hospice program; or
- The patient is receiving treatment for cancer.
The effective date for this mandate is July 1, 2018, provided that the PDMP is certified by DPH as operational. A prescriber found in violation of this code section will be held administratively accountable to the Georgia Composite Medical Board. The General Assembly also recognizes the burden placed on local governments when it comes to performing autopsies on overdose victims. We recently added money in the budget for the Georgia Bureau of Investigation medical examiner’s building to increase capacity and relieve pressures on the local governments. This will also speed up the time in which investigators can identify illicit substances on the streets and identify hot spots where mortalities are expected to rise dramatically in hours, increasing the ability to have resources on hand to reverse overdoses and make arrests of suppliers or distributors.
It’s also important to not get tunnel vision when addressing this multifaceted issue. Preventing overdoses with state funded authorities is just as important as outreach prevention and education programs in communities and on school campuses, which will require local support and funding.