State Legislature

Amid opioid epidemic, six Colorado proposals could fight trend

Supervised-injection facility, Medicaid and private insurance changes among suggestions

Posted 12/22/17

When state Rep. Brittany Pettersen was a child, her day started with finding and hiding her mother’s keys, pouring out her alcohol and pills, and then going to school. She’d get home, and she’d …

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State Legislature

Amid opioid epidemic, six Colorado proposals could fight trend

Supervised-injection facility, Medicaid and private insurance changes among suggestions

Posted

When state Rep. Brittany Pettersen was a child, her day started with finding and hiding her mother’s keys, pouring out her alcohol and pills, and then going to school. She’d get home, and she’d do it all over again.

“It took me probably, maybe being 9 years old, to recognize that my mom was very different from most parents,” said Pettersen, a Democrat representing the Lakewood area.

She was concerned about her mom, but she didn’t know what to do.

Her after-school routine grew to include checking to see whether her mom was breathing.

Pettersen’s mom, Stacy, had an opioid addiction from the time she was about 33. After being overprescribed for her back pain, she developed a dependency that escalated to heroin use when another doctor cut her prescription. After several recent trips to the ER from overdosing, she finally asked for help — the words Pettersen said she waited 29 years to hear.

She was far from alone in her fears. Colorado saw 108 opioid-related deaths — involving prescription drugs, heroin or both — in 1999, according to the Colorado Department of Public Health and the Environment.

In 2016, in that same category, the state saw a death count of 504.

Now, Colorado legislators are putting forth six bills to make sure opioid substance abuse doesn’t progress that far. Spearheaded by Pettersen, the Opioid and Other Substance Use Disorders Interim Study Committee aims to tackle the problem from all sides: in the medical world, the law-enforcement field, the health-care industry and — perhaps most directly — where people inject drugs.

Safe place amid the stigma

The most visible effort, if passed, would allow a pilot project for a supervised-injection facility — where people with substance-use disorders can safely inject drugs — in Denver.

No other place in the United States has such a facility, according to the Colorado Legislative Council Staff, but there are 100 of them in 66 cities among nine countries, said committee member state Sen. Cheri Jahn, D-Wheat Ridge.

Health professionals would oversee the facility, making sure to reverse overdoses if they happen, Pettersen said. They’ll also be able to refer people to resources to beat their substance-use disorder.

“This is about keeping people alive today, bringing them out of the shadows and increasing the likelihood they’ll get treatment,” Pettersen said.

Some in the business and law-enforcement communities may be concerned about the facility normalizing drug use, Jahn said, but to her, the apprehension is misplaced — localizing drug use to one safe area could help make businesses, parks and alleyways more safe, she said.

“Nothing is gonna impact a business more than when someone walks in for coffee and they walk into the bathroom and find someone dead,” Jahn said.

“You want your kids (passing) used needles on their way to school?” she added.

Committee member state Rep. Chris Kennedy, D-Lakewood, said the business community has been “wildly supportive” of the idea, because of the problem of people overdosing in bathrooms.

The facility would also reduce the spread of HIV and hepatitis C, Pettersen said.

“You and I are never going to go do heroin (just) because this place exists,” she added.

Going to the source

The proposals would also require health practitioners to check a database that could prevent writing dangerous prescription refills and create training programs to help them better understand the opioid issue.

The Prescription Drug Monitoring Program collects information submitted by pharmacies about prescribing and dispensing medications, and about patients. Such a statewide database exists in nearly all states, according to the PDMP Training and Technical Assistance Center, but it’s not mandatory for doctors in Colorado to check it before writing prescription refills.

It would answer questions like, “Do we have someone at risk of addiction, or are they addicted? Are they doctor-shopping?” Jahn said, using a term for when patients go to multiple doctors seeking more drugs.

For initial prescriptions, people with acute conditions — getting a tooth pulled, or other short-term issues — would be limited to a seven-day supply of pills for one prescription, in most cases. Chronic, or long-term, conditions would be among the exceptions, Jahn said.

Committee member state Sen. Jack Tate, R-Centennial, said the problem in his district is a latent supply of opioids.

“My sense is we don’t have as high an addict population as many (areas),” Tate said.

But the supply in people’s cabinets, waiting to be grabbed by teenagers or otherwise misused, is the danger, he said.

The proposals are expected to direct a research center at the University of Colorado Anschutz Medical Campus in Aurora to develop best practices for training medical professionals how to safely prescribe drugs, as well as how to disseminate that training, Jahn said. That research center for substance-use disorder prevention at that campus was green-lighted by Senate Bill 17-193 in May — Pettersen and Jahn were main drivers — but this proposal reiterates its goals, Jahn said.

Filling treatment gaps

About a year and a half ago, Stacy Pettersen, 63, experienced a string of trips to the emergency room from overdosing and ended up in the intensive-care unit, her daughter said. Stacy finally asked for help with her condition, but was told that Medicaid doesn’t cover treatment.

“We’re spending tens of thousands of dollars keeping people alive and then denying them the help they need to get better,” Brittany Pettersen said. “So that was devastating and I think highlighted for me the enormous gap we have in our system.”

In 2015, at least 87 of Colorado’s overdoses from prescription opioids alone — not including heroin — happened to Medicaid recipients, according to state data. That makes getting Medicaid recipients residential, or live-in, treatment a priority for the lawmakers.

“Residential means that (you’re) going to go into a facility and stay there — could be anywhere from two to four weeks,” Jahn said. They “get the intense counseling, the therapy: How do I live with my disease once I leave here? How do you put me back into the real world?”

Generally, Medicaid covers some care for substance-use disorders in Colorado, including counseling and medications to help treat them, but that doesn’t work for everyone, Pettersen said. Lawmakers’ proposals would add inpatient and residential treatment as more widely covered.

“Treatment should not just be for the wealthy or people with good insurance plans,” Jahn said.

Another arm of the proposals would make insurance plans more cheaply cover alternatives to opioid drugs for pain — physical therapy, chiropractic care and acupuncture — to make sure patients aren’t unnecessarily pushed toward opioids, Kennedy said. It would also bar “step therapy,” a requirement that patients try opioid medications before receiving non-opioid drugs, for both private insurance and Medicaid.

“Even if a drug is covered by Medicaid or an insurance company, that doesn’t mean you can actually (get it),” said Kennedy, who is spearheading the proposed insurance changes.

He’s also pushing to change the requirement that patients get “prior authorization,” a green-light from an insurance provider, to know that medication-assisted treatment will be covered. That involves a combination of psychotherapy and drugs that help fight opioid addiction, he said.

The proposal aims for quicker response times from both Medicaid and private insurers to requests for medication-assisted treatment. Currently, many insurers may take too long to authorize payment for those treatments, leaving patients unable to pick medications up at a pharmacy, Kennedy said.

“If you’re an addict that says, ‘I’m ready to seek treatment,’ and someone says, ‘OK, wait seven days please,’ there’s a high risk that you might return to heroin to avoid withdrawal symptoms,” Kennedy said.

On the front lines

In Adams, Arapahoe and Jefferson counties, sheriff’s offices said deputies use Narcan, which can be administered as a nasal spray, to reverse the effects of an opioid overdose.

The Adams County Sheriff’s Office expressed support for creating training programs for law enforcement regarding the opioid epidemic.

“By creating a training system for all, it helps us identify and recognize those in need,” said Jim Morgen, spokesman for the sheriff’s office. In “the rural parts of Adams County, we arrive minutes before medical (support) is able to, and we have to be able to recognize somebody having opioid reactions (including) an overdose. These minutes are crucial in potentially saving lives.”

Lawmakers’ proposals include directing the Anschutz Medical Campus’s research center to create training for officers on how to better use naloxone — Narcan is its brand name — in responding to overdose situations.

Jahn also said she believes crime would be reduced by creating supervised injection facilities because more people would have access to treatment.

A person “would not have stolen all these goods if (they) didn’t have an addiction (they) needed to feed,” Jahn said, speaking hypothetically. Law enforcement officials in Wheat Ridge, other Jefferson County areas and Denver have told her that increases in property crimes have been tied to substance-abuse disorders. Police in Englewood and Littleton have made similar observations, referencing opioids.

“If they were able to get it more easily, or get it at all, we have a better chance,” Jahn said. “People don’t want to live like this.”

End of a journey

Stacy Pettersen’s lack of Medicaid-covered care left her daughter with few options.

People Brittany Pettersen worked with to address the state’s opioid issue recommended an involuntary commitment process — by which she’d receive a court order for her mother to be taken to paid-for treatment. Stacy Pettersen recently began a program at a rehabilitation center after two months in a program where she underwent detox.

In early 2018, she’s expected to complete her rehab program, and Pettersen said her mom is learning to live again. At a dinner with family, relatives went around the table and said what they were grateful for, and everyone said they were thankful for her.

“It was very emotional,” Pettersen, 36, said. “To have her there and sober and be alive, and how every day is the best day ... it’s like she’s been frozen for 29 years. That’s a lot to deal with, the years that have been lost, but she’s thankful to be alive.

“For the first time in 29 years,” Pettersen said, “I have my mom in my life.”

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