With report submitted to governor, Nevada could act on opioid abuse

By Daniel Rothberg

Monday, Nov. 21, 2016 | 2 a.m.

First responders know all too well that there is a brief window during which the effects of an opioid overdose can be reversed by a medicine known as naloxone. It’s no cure to the opioid epidemic, but it has become an essential tool for first responders.

Parents or other witnesses can administer it and call 911, then continue with chest compressions, says Joe Engle, a Henderson resident whose eldest son, Reese, died of a heroin overdose in 2011. But Engle says access to naloxone often is limited by a high price for the prescription drug, insurance companies dragging their feet and little training for parents who might need to administer it.

“The whole thing is broken,” said Engle, president of There is No Hero in Heroin, a foundation that offers education about opioid addiction and treatment. “No one is working together.”

Health experts recommend the state continue to emphasize access to naloxone as it considers how to address an opioid epidemic that has withered communities throughout the country. The issue has been especially acute in Nevada, where for every 100 Nevadans, doctors write 94 painkiller prescriptions, which can open the door to heroin use.

This fall, Gov. Brian Sandoval mobilized a summit of national experts to provide recommendations about how Nevada should address addiction to prescription painkillers and opioids. He has been active on the issue, signing the Good Samaritan Drug Overdose Act, which expanded access to naloxone and provided a measure of immunity from low-level drug offenses for calling 911 as a witness of an overdose.

“I am proud of what we have accomplished,” Sandoval said in a statement. “But there is more work to be done, and the summit helped provide a framework for the policy changes we will look to implement during the next regular session, and also created guidelines for a collaborative path forward.”

Policymakers, health care providers and first responders examined the issue this fall during a two-day summit by looking at four areas: prescriber guidelines, treatment options, criminal justice intervention and data collection. In a summary of findings from the meeting, released last month, the recommendations for action and possible legislation focused on three areas:

• A data-driven approach: Nevada already uses data to find trends about overprescribing and patients who shop for doctors willing to write prescriptions for opioids. The report recommends making it easier for different parties, from law enforcement to public health professionals, to share data through agreements that comply with privacy laws. Many recommendations focus on creating a centralized data center to inform policy decisions.

• Raise public awareness: These recommendations include providing more information about medical interventions like naloxone and creating a website to help Nevadans report concerns about prescription drug abuse. Another key outreach suggestion was to educate physicians about non-opioid pain management and how insurance covers those options.

• Make resources accessible: In this area, the summary of findings recommended expanding accessibility to medication-assisted treatment, which addresses substance abuse with a combination of therapy and medication. It also stressed the importance of confronting workforce shortages, especially in rural areas, and considered deploying mobile medical units to more areas. The report also recommended screening patients for signs of substance abuse and providing those patients with early treatment.

The summit and its findings stemmed from a multiyear effort by Sandoval to address prescription drug abuse, which has been tied to the uptick of heroin-related deaths across the U.S. A task force led by first lady Kathleen Sandoval developed a statewide action plan, and the summit’s goal was to pull together recommendations before the Legislature meets next year.

Engle called the findings a “step in the right direction” but cautioned against a punitive approach that relied on law enforcement rather than one that included treatment and preventive measures.

“We need to figure out how to stop the bleeding,” he said. “We’re hemorrhaging right now.”

Many of these efforts coincide with a renewed focus at the federal level on addiction and a recognition of the need to shift away from a “war on drugs” mentality that led to a steep rise in incarceration and largely affected communities of color. The U.S. surgeon general, for instance, has pledged to release this year the first-ever report on substance abuse and addiction. And the Obama administration has urged Congress to approve $1.1 billion in federal funding to confront the issue, a move that could leave Nevada with a $9 million apportionment of funds.

A spokesperson for the WestCare Foundation, a national nonprofit organization that provides treatment in Nevada, emphasized the importance of early intervention, closing loopholes in the health system that might push a patient to heroin, and tackling co-occurring issues such as mental health.

“As an agency passionate about public health care, the message we want to help keep in play is the same message that came from the summit: We know that the addiction problem is stemming from a crisis in our health care system,” said Robert Vickery, WestCare’s director of communications.

“We are seeing a phenomenon,” he added.