Directly Speaking - Illinois House Heroin Task Force: Focusing On the Problems

On Tuesday, October 7th, a small group of pharmacy profession representatives met with Representatives Lou Lang (D) and Dennis Reboletti (R), co-chairs of the Illinois House of Representatives Heroin Task Force in downtown Chicago to address an issue that currently plagues Illinois. Reps. Lang and Reboletti asked the pharmacy community for help with this critical and growing problem. The profession was represented by Rob Karr, President of the Illinois Retail Merchants Association (IRMA); Garth Reynolds, Executive Director of the Illinois Pharmacists Association (IPhA); Joel Baise, Walgreens; Kathryn Schultz, Gary Peksa and Scott Meyers, ICHP’s Director of Government Affairs, members of the Division of Government Affairs, and Executive Vice President, respectively. (Kathryn and Gary attended at the request of House staff and me.)

Representative Lang began the meeting with a description of the Task Force (39 members of the House from both sides of the aisle – that means it is bi-partisan) and then highlighted the goals of legislation. Important to the Task Force was creating language that could be voted on in November during the Veto-session of the Illinois General Assembly. That’s a very ambitious plan. The primary goals of the Task Force are:

Reduce deaths from heroin overdose

Reduce access to prescription opioids that may lead to heroin use

Strengthen efforts to combat heroin use and addiction in Illinois

Rep. Lang discussed three major areas the bill would address:

Over-prescribing of opioid medications

Pharmaceutical Take Back Programs

Strengthening the Prescription Drug Monitoring Plan (PMP)

The Representatives questioned the value of flagging patients who receive prescriptions for controlled substances from six doctors or six pharmacies in a 30-day period and the limited value of then sending the prescribers involved with that patient a letter advising them of the situation. Should or could the current PMP processes be tightened? The Task Force would like to use prescriber data from the PMP to identify those physicians who prescribe high quantities of controlled substances. Is the number of prescriptions reasonable for their area of practice? The question of auto-registration to the PMP at the time of physician licensure renewal by IDFPR (Illinois Department of Financial and Professional Regulation) was raised as a means to encourage and facilitate physician utilization of the PMP. Are physicians actively logging onto the PMP to build their accounts (currently a voluntary process) and would auto-registration facilitate use of the PMP by more doctors? They asked if pharmacy had any barriers in accessing the PMP. The answer we provided was not to our knowledge.

The Task Force does not want to encourage or allow fishing trips by the DEA or law enforcement, taking large volumes of data to identify frequent controlled substance users, but would condone the use of PMP data by IDFPR to follow-up with frequent prescribers. This will likely be a problem for the Illinois State Medical Society. 

Rob Karr stated to Reps. Lang and Reboletti that he felt that since the physicians constantly maintain that they are the “gatekeepers” to the healthcare process, then isn’t it appropriate that they (the physicians) be required to check the PMP prior to prescribing controlled substances? (At least whenever the physician is dealing with a new patient.) Having the PMP interface with electronic prescribing software could facilitate this process and reduce the time burden on the doctors. That’s a discussion that needs to occur with e-prescribing software companies. It was the pharmacy representatives’ consensus that the pharmacist should not be required to check the PMP unless the physician is at least required to do the same.  

We explained to Reps. Lang and Reboletti that currently the PMP is not a real-time tool but can be up to 7 days behind in showing filled prescriptions. The question was asked if making the PMP a real-time tool would improve detection of doctor and pharmacy shoppers. It was reported that Oklahoma has a real-time system that is frequently down because of the additional maintenance and load. In addition, switching to real-time is costly for both pharmacies and the State. 

Pharmacy Take Back Programs were discussed at length. Rep. Lang suggested that the bill could require all pharmacies to participate in these programs in order to remove more prescription medications from homes. Those in attendance raised issues of space, security and cost requirements for these programs. The Task Force believes that these programs should be widespread and on-going. Occasional local programs are not sufficient to help solve the problem of access to opioid products by teenagers and young adults, and additionally, law enforcement agencies are not willing or able to take on these programs by themselves. The Representatives were understanding of the cost issue and also did not realize their impact on work space, work flow and overall security of the pharmacy. They were also unaware that many of the meds that are returned with these programs are not easily identifiable because they have been removed from their original containers or were originally provided to the patients in Med Paks rather than prescription bottles.

Naloxone availability to rescue overdose victims was also discussed and it was a unified recommendation by the pharmacy representatives in the room that intranasal (IN) administered naloxone should be the only medication considered safe for distribution to the general public and law enforcement. There are also concerns with providing a prescription medication to someone other than the potential patient. The state would have to provide some sort of standing order for pharmacies to be able to prescribe and dispense intranasal naloxone to a family member or concerned friend of a heroin user. Rep. Lang said that could be written into the bill. There was some limited concern by the Representatives for preventing dealers from buying the intranasal naloxone for their customers as a means to maintain business, but the risk/value didn’t seem too significant of an issue in making naloxone more accessible overall.

Representative Lang asked the pharmacy organizations to come up with some proposed language within 30 days that would help the Task Force accomplish its goals while hopefully not causing significant burden on pharmacies. Much of this will impact community pharmacy practice and hospital pharmacies alike, not necessarily just those with outpatient pharmacies. It may be quite possible that hospitals that have pharmacies within their walls would have to provide access to a Take-Back program and the inpatient pharmacy would be responsible.

The new DEA rules that allow pharmacies to now “Take Back” unused and expired controlled substances may be used by the General Assembly to force every pharmacy to do just that! ICHP’s Division of Government Affairs will be working diligently to make sure whatever the Task Force comes up with is reasonable and fair to all.