Gov. Cuomo Puts New Tactics Into Fight Against Raging Heroin, Opioid Crisis in New York State

New York State Gov. Andrew Cuomo isn't playing games when it comes to taking on the most devastating health crisis this generation has arguably ever seen as the opioid epidemic continues to escalate.

Last week, Cuomo signed legislation to combat the heroin and opioid crisis that's claiming countless lives across the board.

The comprehensive package of bills was passed as part of the 2016 legislative session and "marks a major step forward in the fight to increase access to treatment, expand community prevention strategies, and limit the over-prescription of opioids in New York", a release from Cuomo's office said.

Included in the legislation are several best practices and recommendations identified by members of Cuomo's new heroin and opioid task force, launched last month.

“New York is leading the way forward in the fight against heroin and opioid addiction, and with this legislation, we are taking an affirmative stand for our families and communities who have suffered from this epidemic’s debilitating effects,” Cuomo said. "I commend the Senate and the Assembly for their hard work and dedication to stopping this epidemic and creating a stronger and healthier New York."

The new legislation includes initiatives to address heroin and opioid abuse statewide such as:

• measures to increase access to life-saving over-dose reversal medication
• regulations to limit opioid prescriptions from 30 to seven days
• ongoing prevention education for all physicians and prescribers.

The legislation aims to remove "burdensome" barriers to access for inpatient treatment and medication.

Specifically, the legislation will put an end to prior insurance authorization to allow for immediate access to inpatient treatment as long as that treatment is needed.

In addition, the legislation establishes that utilization review by insurers can begin only after the first 14 days of treatment, ensuring that every patient receives at least two weeks of uninterrupted, covered care before the insurance company becomes involved.

Second, the legislation shatters boundaries by ending prior insurance authorization to allow for greater access to drug treatment medications.

In the past, prior approval was often necessary, slowing down the process of getting the medication to the patient. The new legislation prohibits insurers from requiring prior approval for emergency supplies of these medications. Similar provisions will also apply to managed care providers treating Medicaid recipients who seek access to buprenorphine and injectable naltrexone.

The new legislation also requires all insurance companies to use objective, state-approved criteria to determine the level of care for those suffering from substance abuse.

And the new law mandates insurance coverage for opioid reversal medication, Naloxone.

Cuomo's plan also calls for enhanced addiction treatment services, including increased evaluation for individuals incapacitated by drugs from 48 to 72 hours; requires hospitals to provide follow-up treatment after discharge; allows additional trained professionals to administer Narcan without risk to their licenses; and expands "wraparound services," such a education, employment resources, legal services and transportation to help support long-term recovery.

Strengthened community prevention strategies include reduced prescription limits for opioids from 30 days to seven days.

"There is a well-established link between the rise in opioid prescriptions and the current heroin crisis. To reduce unnecessary access to opioids, the legislation lowers the limit for opioid prescriptions for acute pain from 30-days to no more than a seven-day supply, with exceptions for chronic pain and other conditions," Cuomo's release stated.

The law also calls for ongoing education on addiction and pain management for all doctors and prescribers and mandates that pharmacists provide easy to understand information on the risks associated with drug addiction.

Data collection on overdose and prescriptions will also be required to help the state provide additional resources to fight the opioid war.

Of the new legislation, Suffolk County Executive Steve Bellone said: “This comprehensive legislation marks a major step forward in the fight to combat heroin and opioid abuse and end this harrowing epidemic once and for all. This is life-saving legislation will help break the cycle of addiction and ensure our loved-ones have access to the addiction treatment services they need and deserve.”

Added Nassau County Executive Edward P. Mangano, "This legislation is good news as it assists in the battle against drug abuse by providing broader access to treatment, supporting prevention education and increasing access to life saving overdose reversal drugs."

Dr. Jeffrey Reynolds, president and CEO of the Family & Children's Association in Mineola, NY, said, "This package of bills represents a major step forward in strengthening New York's response to the growing heroin crisis."

The package of bills addresses the demand side of the equation by making treatment more accessible, Reynolds said.

"A big thanks is due the governor and the entire legislature for getting these bills done, but an even bigger thanks goes to the families impacted by addiction who courageously shared their stories and put a human face on this crisis."

He added, "Going forward, our push will be on securing the state funding necessary to boost prevention programs, counseling services for families and support services for people in recovery. Our work isn't done and won't be complete until we have put an end to overdose fatalities and are better prepared for the next drug that appears on the horizon. "

Waging the war against heroin

Since 2014, Cuomo has implemented a series of reforms aimed at fighting back against heroin and opioid addiction, including signing the "Combat Heroin" legislation; expanding insurance coverage for substance use disorder treatment; increasing access and enhancing treatment capacity across the state, including a major expansion of opioid treatment services; implementing new and expanded recovery services; and launching a public awareness and prevention campaign to inform New Yorkers about the dangers of opioid use.

In March, new regulations took effect that require all prescriptions to be transmitted electronically from the prescriber directly to the pharmacy. The measure is part of New York’s comprehensive I-STOP law, first implemented in 2012, designed to reign in prescription drug abuse across the state, Cuomo said.

Through I-STOP, New York requires prescribers to consult a prescription monitoring program registry when writing prescriptions for Schedule II, III, and IV controlled substances. The registry provides practitioners with direct, secure access to view dispensed controlled substance prescription histories for patients in real time.
In addition, the data is further used to identify potential sources of prescription drug diversion or abuse, including prescription fraud, Cuomo said.

In April, the state began sharing the prescription monitoring program data with New Jersey to further prevent the stockpiling and resale of dangerous controlled substances.

So far, I-STOP has led to a 90 percent decrease in the number of "doctor shoppers" or patients who visit multiple prescribers and pharmacies to obtain controlled substances within a three-month time period.

As overdose is now the leading cause of accidental death in New York, with Suffolk County reporting the highest number of heroin overdoses, the state has led an effort to make naloxone available without a prescription at approved pharmacies.

Also, New York has trained thousands of first responders and community members to recognize and respond to overdoses with Narcan.

As a result, Cuomo said, more than 3,500 overdose reversals have been documented, with over 1,500 lives saved in 2015.