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What, exactly, is the Legislature doing to address the opioid crisis in Minnesota?

Among other things, some lawmakers want to set up a system that would funnel money into preventive measures — by imposing a fee on the pharmaceutical companies that sell opioids.

Oxycodone pills
Opioids are a class of drugs that includes illegal drugs like heroin, but also includes drugs that doctors prescribe for something as common as pain relief.

Around the Minnesota Capitol, Chris Eaton has been repeating a gruesome line she once heard: “The toe tag on the body doesn’t say Republican or Democrat.”

It’s a sentiment meant to convey to her 200 colleagues in the Minnesota Legislature that the opioid epidemic doesn’t discriminate by political party. It also carries extra meaning for Eaton, a Democratic state senator from Brooklyn Center who lost her daughter to a heroin overdose in 2007. “Everybody’s children and family members are dying,” she said. “It’s not one party or the other.” 

Eaton is just one member of a bipartisan group of lawmakers trying to push a number of proposals through the Minnesota Legislature this year that aim to curb a growing epidemic of  opioid abuse, which claimed 395 Minnesota lives in 2016 alone. The signature piece of their effort is an attempt to pay for preventive measures by implementing some kind of fee on the very drug companies that sell the pills.

That measure — a so-called penny-a-pill fee — is also controversial, with pushback from business interests and some conservative groups. It’s also not the only effort at the Capitol trying to address the issue. With just six weeks left in the 2018 legislative session, here’s a look at where things stand on the Legislature’s efforts to tackle Minnesota’s opioid crisis.

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What are we talking about when we talk about opioids?
Opioids are a class of drugs that includes illegal drugs like heroin, but also includes drugs that doctors prescribe for something as common as pain relief. The latter group includes fentanyl and other pain relievers such as oxycodone and hydrocodone (more commonly known by its trade name, Vicodin, which also contains acetaminophen), and drugs like morphine and codeine. Opioids are powerful in treating pain, but they’re also highly addictive.

So how bad is the problem?
The number of people addicted to opioids has continued to rise — as have overdose deaths. The nearly 400 deaths in Minnesota in 2016 was an 18 percent increase over the year before, and since 2000, opioid overdose deaths have grown by 600 percent, according to the Minnesota Department of Health. Heroin-involved drug overdose deaths in Minnesota increased 32 percent from 2015, a figure that has steadily increased since 2010. The 2016 death of Prince was the most high-profile case of an accidental overdose of fentanyl.

The number of opioid deaths has grown so rapidly that the problem is approaching the scope of the AIDS epidemic of the 1980s and 1990s. In 2015, there were 52,404 lethal drug overdoses in the U.S., with opioids the cause of many of them. That year, 20,101 overdose deaths were related to prescription pain relievers, while another 12,990 deaths were related to heroin overdoses, according to the Centers for Disease Control and Prevention

How have Minnesota lawmakers addressed it so far?
The issue has been up for debate at the Capitol for more than five years, and some changes have been made. In 2014, the Legislature passed Steve’s Law, which addressed two major issues in curbing the opioid problems plaguing the state. 

First, the proposal granted immunity for people who called 911 to help someone who is overdosing on opioids, even if they were users themselves. Eaton carried that proposal in the Senate based on her own family’s experience. Her daugher, 23-year-old Ariel Eaton-Wilson, died in the parking lot of a Burger King while she was overdosing; the man with her that day did not call 911 immediately, instead hiding needles from the police. The bill also allowed first responders, police officers and others to carry and administer naloxone, a drug that counteracts the effects of an overdose. 

But even with that success, Eaton said there’s more that needs to be done.

“We don’t have a system setup for opioid addiction in Minnesota. We have kind of a system for alcohol, but they are kind of different animals,” Eaton said. “We are in the middle of an epidemic and we need a more organized and concerted effort to tackle the problem.”

So what are they trying to do now?
Some lawmakers want to set up a system that would funnel money every year into preventive measures, more treatment and equipping more law enforcement and first responders with naloxone. That money would come from a so-called “stewardship” fee on every opioid sold by a drug company. It’s most commonly referred to around the Capitol as the penny-a-pill proposal, which supporters estimate would raise $20 million every year for treatment and prevention efforts.

Gov. Mark Dayton was on board with the bill, but several weeks into the 2018 session, the proposal in the Senate was tabled in a key committee by its author, Sen. Julie Rosen, R-Fairmount. Meanwhile, the House bill, carried by Rep. Dave Baker, R-Willmar, had the penny-a-pill provision of the bill stripped out; instead, it used money from the general fund to pay for the state’s efforts.

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Who opposes this idea?
Well, the pharmaceutical companies, for one. Nick McGee, with the Pharmaceutical Research & Manufacturers of America, said the industry doesn’t oppose some of the ideas for treatment and preventive measures in Baker or Rosen’s bills, though it has pushed back on the funding mechanism. The group has also come out in support of a number of policy proposals that have surfaced in other parts of the country, including proposals to limit initial users to seven-day prescriptions, even if the doctor orders scripts for much longer.

“We support generally a lot of the programs that the bill includes. Our issue is with using a tax on legitimately prescribed medications that patients rely on as a funding mechanism for the states’s budget,” he said. 

Republicans are also feeling pressure from conservative groups, including Americans for Prosperity, the advocacy group funded by David and Charles Koch, which argues the state already overcollects taxes and fees, and it should use the resources it has to pay for opioid preventive measures. The group has written letters to legislators on the proposal and sent out an action alert earlier this year.

“Minnesota has numerous options to fund opioid response programs without increasing the burden for patients,” Jason Flohrs, the executive director of AFP Minnesota, said. “The Legislature could use ‘surplus’ revenues in the general fund, dedicate existing Medicaid rebate funds already paid to the state by pharmaceutical companies, or leverage incoming additional federal funds designated for opioid response.”

Are there other proposals out there to raise money for opioid treatment and prevention?
Baker pulled the penny-a-pill proposal from his bill, but he said he’s now considering adding a new licensing fee for drug manufacturing companies. “I think a licensing fee increase is a very reasonable request. Currently [drug companies] pay $235 a year to sell as many opioids as they want,” Baker said. “I think if we put it on a tiered system it might make better sense to help us with some infrastructure needs that we have.”

That new fee could raise up to $2 million a year for opioid preventive measures in addition to some kind of general fund revenue, Baker said. That’s not nearly as much as the penny-a-pill proposal would raise, but it’s important to Baker that the drug companies are part of the solution.

“States are recognizing that we can’t ignore the fact that folks that need to be at the table have got to come to the table, or we’ll get them there in ways they don’t like,” said Baker, who lost his son to an opioid overdose after he was prescribed the drug for an injury.

What are other states doing?
New York made history in last week when it became the first state to pass a proposal to require opioid manufacturers and distributors to pay a whopping $100 million annually — via assessments paid into stewardship funds, as Minnesota is proposing  — designed to cover the costs of prevention, treatment and recovery programs. Similar bills are pending in at least a dozen states, according to the National Conference of State Legislatures.

Are there other bills trying to tackle the opioid issue?
On Tuesday, a House committee looked at several proposals, including a bill from Rep. Matt Dean, R-Dellwood, to give $1 million to the Department of Health to create a pilot program for EMTs and ambulance services to connect with patients who are discharged from a hospital after an opioid overdose episode — with a priority on patients who were given naloxone. 

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A different bill from Dean would also require physicians who prescribe controlled substances to get at least two hours of continuing education credit on best practices in prescribing opioids and controlled substances in order to renew their licenses.

A bill from Republican Rep. Ron Kresha would put $2 million into replicating a successful opioid prevention pilot project through St. Gabriel’s Health Family Medical Center in Little Falls. There, doctors and nurses have already developed a guide to best practices on how to prevent patients from becoming addicted to opioids.

“We started in our clinic walking ourselves through every single patient we had on controlled substances,” said Dr. Kurt DeVine of St. Gabriel’s. “Over those three years we’ve stopped almost 500 people’s medication that they didn’t really need.”

“There is no easy fix. There is no magic program,” Kresha said. “It’s a grind. It’s day in day out just trying to take pills off the street.”