ST. PAUL, MN – Joined by health care providers and state health experts, Lt. Governor Tina Smith today announced new guidelines designed to cut the risk of opioid addiction. The new guidelines were developed by a work group made up of health care providers and community partners, and will help doctors and other health care providers decide when to prescribe these powerful pain killers, how much to prescribe, and how to monitor their use.

 

“These new guidelines build on the important steps we have taken in Minnesota to address the opioid epidemic. But we cannot expect to make meaningful progress without a significant and sustained investment in prevention, treatment, and recovery,” said Lt. Governor Smith. “I thank the health care providers and other experts who developed these new guidelines. I look forward to working with them and a bipartisan coalition of lawmakers next session to find a solution to this crisis, and save lives.”

 

Opioid addiction has had a devastating effect in Minnesota, and across the country. Overdoses involving prescription opioids account for more than any other drug, and the great majority of heroin and other illicit opioid users started with prescriptions. In 2016, 376 people died from opioid overdoses in Minnesota, a 12 percent increase over the previous year. And there are over 5,000 new chronic opioid users annually among those who are enrolled in public health care programs administered by the Minnesota Department of Human Services (DHS).

 

“The opioid crisis affects all Minnesotans, including the most vulnerable, like newborns who suffer withdrawal if their mothers used opioids while pregnant” said DHS Commissioner Emily Piper. “We must do all we can to prevent and treat addiction to these drugs.”

 

The new guidelines, currently in draft form, aim to curb the number of unnecessary opioid prescriptions for acute pain and promote effective alternatives; encourage careful monitoring of prescription opioid use; and encourage compassionate care for chronic opioid users to help them to decrease opioid use over time. The new guidelines note that the phase of care after acute pain is critical for preventing long-term opioid use. The use of opioids is not the best option for treating chronic pain and may actually worsen it.

 

“For too long Minnesota's health care community, like that of the rest of the nation, has not addressed the problem of pain management in a comprehensive manner but has relied on expedient and largely ineffective solutions such as pills, procedures and quick visits,” said Chris Johnson, MD, chair of the Opioid Prescribing Work Group. “While opioids have an important role to play in pain management, it is time to acknowledge their serious risks and limitations as we move away from looking upon drugs as the answer. This is an important first step towards safer and better care of patients."

 

The new guidelines were developed collaboratively by the Opioid Prescribing Work Group, a group of physicians, pharmacists, and consumer and law enforcement representatives, as well as staff from the Minnesota Department of Human Services, the Minnesota Department of Health, and the Minnesota Department of Labor and Industry. Public input was solicited throughout the development of the new guidelines. Now that these draft guidelines have been released, a 30-day public comment period begins.

 

“The guidelines being rolled-out today put in place consistent, statewide recommendations for all health care providers who prescribe opioids,” said Dr. Rahul Koranne, Chief Medical Officer, Minnesota Hospital Association. “Minnesota hospitals and health systems are working to decrease both the amount of opioids prescribed and the variation in prescribing among health care providers. We are ready to work with DHS to implement these guidelines to achieve those goals.”

 

The work group operated under the Opioid Prescribing Improvement Project, a two-year program created in 2015 under a bipartisan proposal in the Minnesota Legislature signed into law by Governor Dayton. In the coming months, DHS will issue individualized reports based on the new guidelines, to help providers compare their prescribing practices with those of similar providers.

 

Minnesota officials are encouraging all providers statewide to adopt the new guidelines. Providers whose prescribing is excessive and who participate in Medical Assistance and MinnesotaCare will be required to participate in a quality improvement program to help them meet the new standards.

 

This week, federal officials awarded the Minnesota Bureau of Criminal Apprehension (BCA) $1,402,292 to address and respond to the unlawful distribution of heroin and other illicit opioids. In Minnesota, this funding will be used to prevent illicit opioid use and misuse through a data-driven, collaborative, and coordinated approach between the BCA and community and healthcare partners.

 

Among the efforts this new funding will support, Minnesota officials will focus on:

 

o    Provide overtime opportunities to law enforcement who target drug traffickers supplying heroin and other opioids to our citizens in Native American communities.

o    Aggressively investigate traffickers linked to fatal opioid overdoses and investigate drug diversion cases including practitioners operating outside the law.

o    Hire two special agents, and a new management analyst who will provide analytical support of heroin and other opioids use and trafficking. 

o    Utilize the most current technologies when investigating heroin and other opioid traffickers.

 

o    Collaborate with the Minnesota Indian Affairs Counsel on heroin and other opioids abuse in Native American communities, including a presentation on program goals and overtime reimbursement opportunities.

o    Bring anti-heroin stakeholders together for a monthly “call-in” to discuss trends, investigations, overdoses, and overtime reimbursement.

o    Collaboratively identify best practices for case reporting and overtime reimbursement.

o    Work to obtain stakeholder support for a Minnesota Drug Monitoring Initiative and reporting of naloxone deployments.

 

Lt. Governor Smith again urged the Legislature today to hear and pass legislation establishing an Opioid Stewardship Program. This program would require opioid manufacturers to pay a “penny a pill” fee, which would generate $42 million every two years. These funds would be dedicated exclusively to opiate abuse prevention and treatment in Minnesota. The proposal was sponsored by State Senator Julie Rosen, State Senator Chris Eaton, and State Representative Dave Baker, and included in Governor Dayton’s 2017 Supplemental Budget proposal. Unfortunately, the bill did not receive a legislative hearing in the House of Representatives last session, and was not approved by the Legislature. 

The following efforts are already underway to address opioid abuse prevention, emergency response, treatment and recovery, and more in Minnesota. 

 

Opioid Abuse Prevention Pilot Projects – In 2017, Governor Dayton and the Minnesota Legislature provided a $1 million one-time grant to build on a successful treatment approach, establishing opioid abuse prevention pilot projects in Minnesota. This grant will build capacity among health care and other service providers to prevent and treat opioid addiction, especially in rural Minnesota. The 2017 Health and Human Services budget also included a $1 million one-time investment for a chronic pain rehabilitation therapy demonstration project. 

 

Federal Strategic Prevention Framework for Prescription Drugs – In 2016, Minnesota received a $1.5 million federal grant over five years to prevent and reduce opioid abuse and reduce opioid overdoses. The grant requires that state agencies: 1) design, implement, enhance, and evaluate primary prevention efforts using evidence-based methods; 2) work with pharmaceutical and medical communities on risks of overprescribing; and 3) raise community awareness and bring opioid abuse prevention activities and education to schools, communities, parents, prescribers, and their patients. 

 

Limiting Opioid Prescriptions and Improving Warning Efforts – In 2017, Governor Dayton and the Legislature passed a law requiring opiate prescriptions to contain a label that says “Caution: Opioid: Risk of overdose and addiction." The bill also limits opiates to a four-day supply for certain situations of dental or ophthalmic pain but provides health care providers discretion if he/she determines that a larger quantity is needed.  

 

Pharmacy Drop-Off Sites – In 2016, the Legislature passed and the Governor signed legislation allowing any Minnesota pharmacy to be a drop-off site for unused prescriptions, including opioids. 

  

Steve’s Law – In 2014, Governor Dayton and the Minnesota Legislature enacted "Steve’s Law,” which allows non-health care providers to administer Naloxone, a life-saving drug used to treat those who have overdosed on opioids. The bill also provides immunity from criminal and civil charges if an individual seeks emergency medical assistance in the case of a drug overdose. Immunity is also provided for the individual experiencing the overdose. 

Federal Grant for Naloxone – In 2017, the Minnesota Department of Health (MDH) received a federal grant ($300,000 per year) that will provide funding for the nine emergency medical services regions statewide to purchase Naloxone. 

 

Federal State Targeted Response Grants for Collaborative Treatment Efforts – Minnesota received more than $10 million in federal grants over two years, starting this fall, to help establish more collaborative treatment efforts statewide. The goal of this program is to encourage collaborative care between opioid treatment programs, health care clinics, care coordinators, and County and Tribal entities. Grants will focus on increasing provider capacity to identify and treat opioid addiction (including neonatal cases) and improving access to Naloxone to treat opioid overdoses. 

 

Substance Use Disorder Treatment Reform – In 2017, Governor Dayton and the Minnesota Legislature enacted new reforms to Minnesota’s substance use disorder (SUD) treatment system to move from an acute, episodic-based system to a client-centered model of care, with an emphasis on managing SUD as a chronic disease. These changes remove barriers that have prevented Minnesotans on Medical Assistance from accessing substance abuse treatment. The reform package allows patients to more quickly access services, and adds important services like withdrawal management, care coordination and peer support. 

 

Medication-Assisted Treatment (MAT) for Opioids – In 2017, Governor Dayton and the Minnesota Legislature provided $825,000 for health care providers to purchase direct injectable drugs to treat opioid addiction. The Minnesota Department of Corrections is also developing a strategic plan to expand access to MAT for the criminal justice-system.  The Minnesota Department of Human Services has also received a $6 million MAT expansion grant. The project is a partnership with the Red Lake Nation, the White Earth Nation, and Fairview Health Services.   

 

Integrated Care for High-Risk Pregnancies – This Legislation passed and was signed by the Governor in 2015 to support five Minnesota tribes to provide integrated services to identify and treat pregnant mothers and infants exposed to opioids, including community supports. 

 

National Governors Association (NGA) Prescription Drug Abuse Academy – In 2014, Minnesota was selected as one of six states to participate in a year-long prescription drug abuse academy coordinated by the National Governors Association (NGA). This led to the formation of the State Government Opioid Oversight Project (SOOP) with the Minnesota Departments of Human Services, Corrections, Education, Health, Labor and Industry, Public Safety, the State Judicial Branch, Board of Pharmacy, Board of Medical Practice, Board of Dentistry, Board of Nursing and Board of Podiatry. The group meets regularly to coordinate opioid-related activities across state government.  

 

National Governors Association (NGA) Policy Academy – In 2016, Minnesota participated in a National Governors Association (NGA) program focused on coordinating public safety and public health data on opioid overdoses. This led to Governor Dayton’s 2017 budget proposal for $200,000 to improve data coordination between public health and public safety organizations (described in more detail below). 

Governor Dayton also made the following proposals to address the opioid crisis in Minnesota. Unfortunately, these proposals have not been approved by the Legislature.

 

“Penny a Pill” Opioid Stewardship Program – This program would require opioid manufacturers to pay a “penny a pill” fee, which would generate $42 million every two years. These funds would be dedicated exclusively to opiate abuse prevention and treatment in Minnesota. The proposal was sponsored by State Senator Julie Rosen, State Senator Chris Eaton, and State Representative Dave Baker, and included in Governor Dayton’s 2017 Supplemental Budget proposal. Unfortunately, the bill did not receive a legislative hearing in the House last session, and was not approved by the Legislature.

 

Funding to Prevent Opioid Overdoses in American Indian Communities – In 2017, based on feedback from the Opioid Summit, Governor Dayton proposed a $4 million investment to fund prevention programs to reduce opioid abuse among Minnesota’s Tribal Nations and urban American Indian communities. Unfortunately, this proposal was not funded by the Legislature. 

 

Improved Data Coordination between Public Health and Public Safety Organizations – In 2017, Governor Dayton’s budget proposal included $200,000 every two years to fund a drug analyst position at the Bureau of Criminal Apprehension (BCA). This position would allow the BCA to begin work monitoring the drug threat to Minnesota, and to work closely with the Minnesota Department of Health (MDH) and other state and local agencies to allow more timely deployment of opioid response resources throughout the state. This proposal has been requested by law enforcement organizations. Unfortunately, this proposal was not funded by the Legislature. Nonetheless, the BCA is working with MDH on options to more effectively share data on opioids, at the request of Minnesota law enforcement. 

 

Expanded Violent Crime Enforcement Teams (VCET) – In 2017, Governor Dayton proposed investing $1 million in Violent Crime Enforcement Teams (VCET). This founding would expand the number and capacity of multijurisdictional task forces investigating narcotics, gangs, and violent crime statewide. Unfortunately, this proposal was not funded by the Legislature.