Governors Take on Abuse and Access in Opioid Compact

August 4, 2016

State governors are ready to take action on the opioid abuse epidemic. The National Governors Association released “A Compact to Fight Opioid Addiction” on July 13 with the goals of reducing inappropriate opioid prescribing, improving awareness of risks and addiction, and clearing the way for addiction treatment and recovery. The governors plan to use the compact’s principles to establish legislative priorities and shape state budgets.

“Governors have long been at the forefront of efforts to prevent and treat opioid addiction,” the compact notes, “working with health care providers, law enforcement and other stakeholders to mount a comprehensive response to the opioid crisis.” The document follows up on the group’s February 2016 decision to collectively address the issue.

[Read: National Governors Association Undertakes Opioid Guidelines]

Advocates for balanced pain management may appreciate the compact’s endorsement of health plan coverage for comprehensive pain management options, including opioid alternatives. The governors also support better access to recovery treatment and medication-assisted addiction treatment. The compact notes the need for more overdose prevention and harm reduction, such as Good Samaritan laws and measures that make overdose-antidote naloxone readily available.

But while governors may agree on the need to curb opioid and heroin abuse in the United States, not all agree on how to go about it. Seven governors turned down the chance to sign the compact, including Montana’s Governor Steve Bullock. The governor cited concerns about mandating the use of prescription drug monitoring programs and potentially limit prescribing capabilities. The state’s medical association director argued that standard of practice was not meant to be established by state law.

Maine Governor Paul LePage also declined to sign the compact. The governor has opposed expanded access to naloxone, arguing that the measure might foster “a sense of normalcy…around heroin use that serves only to perpetuate the cycle of addiction.” He also complained that the compact did not acknowledge the role of law enforcement.

The compact reiterates the possibility of creating opioid prescribing guidelines that may “be informed by” the Centers for Disease Control and Prevention’s March 2016 guidelines. Such guidelines could include prescription limits, the governors say. Patrice Harris, MD, of the American Medical Association has noted that “prescribing decisions — the decision to prescribe or not to prescribe — [should] stay in the hands of physicians.”

The group plans to report back during its winter 2017 meeting on steps taken by individual governors.

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