Our nation is facing an ongoing opioid epidemic, and the crisis is beginning to surge in Hawaii.
Hawaii ranks 43rd in the nation for opioid-related deaths with low numbers compared to the rest of the states. Hawaii had 5.2 fatalities per 100,000 people caused by opioid overdose, while the rate was 43.4 in West Virginia and 32.9 in Ohio.
However, Maui District Health Officer Dr. Lorrin Pang thinks the opioid problem is just as bad in Hawaii as it is in the rest of the country. “For every one legitimate use of (opioid painkillers) there’s three or four illegitimate uses,” says Pang.
Since 2007, drug poisoning has surpassed motor vehicle accidents as the leading cause of death in the state, and opioids are to blame for about 40% of these deaths. Overdose deaths from opioids have more than doubled, from 25 in 2000 to 59 in 2016. Every year, about 400 people end up in the emergency room with non-fatal opioid overdoses and these overdoses resulted in $9.8 million in hospital costs in 2016.
Opioids, as the name suggests, are opium derivatives. These medications, which include OxyContin, fentanyl, and other synthetics but exclude heroin, are normally prescribed for valid reasons in order to reduce pain, but the medicine is highly addictive and easily abused.
Fatal overdoses are often unintentional. If someone takes a dose that is too high, opioids overpower brain receptors and suppress the body’s impulse to breathe, slowing breathing to a dangerous rate or stopping breathing altogether.
Considering the impact crystal meth has had on the islands and the opioid crisis on the mainland, Hawaii is trying to take preventative measures to diminish addiction rates and deaths caused by opioids before the problem gets even worse. In December 2017, Gov. David Ige released the Hawaii Opioid Initiative Action Plan, laying out an interdisciplinary approach to tackle the multifaceted issue. Now, our Legislature has passed several bills related to opioids and these bills are waiting on Governor Ige to become law or be vetoed.
Requires the inclusion of a label warning of the risks of addiction and death on the packaging of any opioid drug dispensed by a health care professional or pharmacist.
Requires health care providers in the workers’ compensation system who are authorized to prescribe opioids to adopt and maintain policies for informed consent to opioid therapy in circumstances that carry elevated risk of dependency. Establishes limits for concurrent opioid and benzodiazepine prescriptions.
Authorizes pharmacists to prescribe, dispense, and provide related education on opioid antagonists to individuals at risk of opioid overdose and to family members and caregivers of individuals at risk of opioid overdose without the need for a written, approved collaborative agreement; subject to certain conditions.
This bill would make it easier to obtain nalaxone, a medication designed to rapidly reverse opioid overdose. It is estimated that at least half of Hawaii pharmacies would participate once this measure is passed. Kaiser Permanente already offers nalaxone at their pharmacies, so there is no need to go to the doctor to get a prescription.
Allows the use of medical cannabis to treat opioid use, substance use, and withdrawal symptoms resulting from the treatment of those conditions.
Governor Ige announced his intent to veto SB 2407 because “the Department of Health already has a formal evidenced-based petition process, made available annually to patients and physicians, so patients and physicians can apply to add qualifying conditions to the list of uses for medical cannabis.”
The DOH opposes this bill and argues that the FDA already has medications approved to treat opioid addiction and withdrawal and there is not enough evidence to support the effectiveness of using medical marijuana to treat substance abuse.
Congresswomen Colleen Hanabusa and Tulsi Gabbard both issued statements opposing Gov. Ige’s intent to veto SB 2407.
Rep Hanabusa said, “America is managing an opioid epidemic that is killing an average of 91 Americans a day. Medical cannabis provides similar relief for chronic pain patients without the possibility of a fatal overdose. We need to explore every opportunity to help our citizens who are battling addiction to pain killers and other prescription drugs. This is a life or death issue. We know that states that administer medical cannabis programs have much lower opioid addiction rates, and opioid overdoses drop by an average of 25%. According to the March issue of the Journal of Health Economics, ‘Dispensaries – retail outlets that sell marijuana to qualified patients – contribute to the decline in opioid overdose death rates.’ We urge the Governor to reconsider and allow the bill to become law to increase access to medical cannabis for patients dealing with opioid abuse.”
“We are in the middle of an ongoing opioid epidemic in this country and Hawai’i is on the front lines – there are 191 drug-related deaths per year, as well as almost 500,000 active opioid prescriptions, which is enough to serve a third of our population,” said Rep. Gabbard. “With such a stark increase in prescription opioid use and dependence, heroin and synthetic drug overdose, and emergency room visits over the last decade, we must allow legal access to medical marijuana to help prevent opioid addiction and opioid-related deaths. This legislation has the potential to save people’s lives in Hawaii – states like Pennsylvania and New Jersey that have adopted similar policies have seen addiction rates drop and opioid abuse deaths decrease by over 20%. Understanding that people’s lives are at stake, I urge Governor Ige to reconsider and sign this legislation into law now.”
On July 10, 2018, Governor Ige confirmed to legislative leaders that he will indeed veto SB 2407.