Sept. 12, 2016
As opioid drug overdoses
continue to take a toll nationally, Texas physicians continue the push to
spread naloxone ― a medication to reverse the effects of an opioid overdose — to
every corner of the state, according to the Texas Medical Association’s (TMA’s)
September Texas Medicine magazine.
Last year, the Texas
Legislature passed Senate Bill 1462 by Sen. Royce West (D-Dallas), making it
legal for laypeople to administer naloxone outside a medical care setting. The
law cleared the way for physicians to prescribe naloxone not only to patients
but also to family members or friends of those who might be at risk of an
overdose. The law also allows a person or organization acting under a standing
order to distribute naloxone and allows pharmacies to dispense the drug. TMA
strongly supported the life-saving law.
Drug addiction and overdose are
top causes of accidental injury and death among adults. Texans overdose on
illegal opiates such as heroin, as well as legal prescription opioids
(painkillers) such as fentanyl, hydrocodone, and oxycodone. Many deaths can be
prevented if the overdose victim can take naloxone and receive emergency care,
because the drug rapidly blocks the effects of the opioid, even heroin, long
enough for patients to get more advanced treatment.
Since the law’s passing,
Texas physicians have issued several standing orders for pharmacies to allow
anyone to get the drug without a prescription from their doctor. Texas
Walgreens and CVS pharmacies both have obtained standing orders for naloxone because
of the new law. This summer, the Texas Pharmacy Association (TPA) announced it
would implement a physician’s standing order authorizing
pharmacists to dispense naloxone after they had completed a one-hour training course.
“I felt the standing order
was important because we’re currently in a historic opioid epidemic in our
country and our state,” said Austin addiction psychiatrist Carlos Tirado, MD,
who issued the standing order for TPA.
Alicia Kowalchuk, DO, an
assistant professor in Baylor College of Medicine’s Department of Family and
Community Medicine, wrote the blanket order for Walgreens. But she cautions
that naloxone is not a “be-all, end-all,” as the effects of the overdose kit
last only 30 to 90 minutes, while the effects of opioids can last four hours to
12 hours or more.
“They still need treatment
immediately after this kit is used for them,” Dr. Kowalchuk said. “That’s where
you really need the education of the person who’s going to be using the
overdose kit for their loved one or their associate, … that they do need to
stay with the person, encourage them to not use [the opiate] on top of it, and
get them appropriate medical care emergently.”
While the law theoretically
makes naloxone more available, the rising cost of the drug in recent years has
physicians concerned that lower-income Texans are being priced out of the
life-saving medication.
“The price has certainly
gone up quite a bit, and health plans, regulators, and consumers should
certainly demand that the price of this medication does not become inflated.
There is too much at stake for people not to have access to this medication,”
said Dr. Tirado.
TMA has adopted
comprehensive policy on opioid overdose prevention and prescription drug
monitoring. TMA supports “Good Samaritan” legislation that would in certain
situations legally protect drug users who request emergency assistance for a
fellow user who overdoses. TMA wants to continue working with lawmakers to
develop a Good Samaritan law for Texas.
Meanwhile, Texas physicians
are working to raise awareness of prescription drug abuse and lessen the stigma
associated with opioid addicts.
“The medical community by
and large understands that this disorder is more than just having a weak will
or being an unfit or delinquent person or a person fundamentally lacking in
moral character,” Dr. Tirado said. “As more good research on the neurobiology
of addiction comes out, we’re going to see even more awareness and acceptance
of the fact that addiction, if we’re really going to deal with it effectively
in our culture, is better addressed as a chronic relapsing condition, as a
public health matter, and not necessarily as a legal and moral matter.”
TMA is the largest state medical society in the nation,
representing more than 49,000 physician and medical student members. It is
located in Austin and has 110 component county medical societies around the
state. TMA’s key objective since 1853 is to improve the health of all Texans.
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Contact: Brent Annear (512) 370-1381; cell: (512) 656-7320; email: brent.annear[at]texmed[dot]org
Marcus Cooper (512) 370-1382; cell: (512)
650-5336; email: marcus.cooper[at]texmed[dot]org
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