Last fall, Gov. Maggie Hassan called a special session of the Legislature to address the opioid crisis in New Hampshire, resulting in the formation of the Joint Task Force for the Response to the Heroin and Opioid Epidemic. I served on the joint task force and sponsored or cosponsored several pieces of the resulting legislation. I would like to share the results of the efforts of the Legislature to address the crisis over the last year.
The goal of prevention is to decrease the demand for opioids through education, limiting availability of prescription drugs and enhanced law enforcement. Bills passed to address prevention included:
• Requiring drug and alcohol education as part of the school board-approved kindergarten through grade 12 health education program.
• Mandatory standards for prescribing controlled drugs for the boards of medicine, dental examiners, nursing, optometry, podiatry, naturopathic and veterinary medicine including requirements for a more complete pretreatment evaluation, comprehensive use of the PDMP (Prescription Drug Monitoring Program), mandatory use of prescriber-patient contracts, a requirement to establish how many days of opioids a prescription may provide, mandatory minimum follow up for ongoing opioid use and a establishing a provision for referrals to specialists for possible addiction treatment in patients requiring high-dose, long term opioid treatment.
• Requiring ongoing continuing medical education in pain management and addiction for prescribers of opioids.
• Elevating criminal penalties for fentanyl class drugs to the same level as heroin.
• Additional funding for Department of Safety to hire two additional detectives.
• Establish a state grant program to assist state and local law enforcement agencies in addressing the opioid crisis funding Operation Granite Hammer.
• Establishing a commission to study hypodermic needles and syringes (“needle exchange”).
Treatment broadly defined encompasses all efforts to address opiate misuse and addiction for both the patients with this illness as well as those affected by it including their children, families and friends. The Legislature passed bills in this category that:
• Reauthorizes the New Hampshire Health Protection Program, which provides behavioral health and substance use disorder benefits as components of its 10 essential benefits.
• Extends mental health and substance use disorder benefits to traditional Medicaid beneficiaries.
• Establishes a 24 hour hotline in Department of Health and Human Services.
• Establishes a commission to study Narcan.
• Requires insurers to cover first two outpatient visits for treatment of substance use disorders and first 24 hours of inpatient detoxification without prior authorization.
• Requires insurers to standardize criteria for prior authorization for substance use disorder treatment by using American Society of Addiction Management (ASAM) guidelines.
• Requires implementation of a uniform online 2-page medication prior authorization form for providers across insurance carriers.
• Provides additional funding to the Governor’s Commission on Alcohol and Drug Abuse Prevention, Treatment and Recovery for the purpose of expanding treatment program services.
• Allows that evidence of a custodial parent’s opioid abuse or dependence may create a presumption of harm under the Child Protection Act.
• Allows courts to order periodic drug or alcohol testing of parents with addiction and opioid dependency.
• Establishment of statewide grants for drug courts and alternative drug offender programs.
Recovery services include programming and housing options that facilitate long-term maintenance of sobriety. While many private and nonprofit efforts are under way to create these programs including drop-in centers and recovery coach training, the focus of legislative efforts was on funding through the New Hampshire Housing Finance Authority for development of recovery housing.
Per capita New Hampshire state funding to address the opioid crisis prior to the passage of the state budget placed us at 49th out of the 50 states. The Legislature, recognizing that both existing and new initiatives would require a significant increase in funding to address the crisis, passed bills that dedicated more than $105 million for the biennium for prevention, law enforcement, treatment and recovery programming.
Starting with Gov. Hassan’s call to action last November, the legislative effort to address the opioid crisis has been comprehensive and remarkably swift for such a large body and complex process. This was only possible in an environment of bipartisan collaboration and dedication to a shared goal. Unfortunately, this represents only a first step in addressing this epidemic and the broader illness of addiction in New Hampshire. Assessing the impact of this legislation and of the many non-governmental efforts, ensuring adequate staffing and workforce development as well as implementing recommendations of the legislative commissions are just a few of the future challenges facing the state. Solving this health crisis will require a long-term commitment from the Legislature to continue to consider the opioid epidemic as one of its highest priorities.