Continuing efforts to gather public and professional input on Ohio's growing prescription drug abuse epidemic, House lawmakers visited Toledo's ProMedica Hospital in early September for the third stop on the House Prescription Drug Addiction & Healthcare Reform Study Committee's tour of the state.
For months, lawmakers in the General Assembly have heard testimony on shortcomings in current drug abuse treatment and prevention systems in the state - particularly as they've examined the issue of Medicaid expansion.
The new study committee, which aims to look more closely at the issue, previously has traveled to southeast Ohio and Hardin County to hear testimony from local officials, law enforcement, addiction professionals and others.
Committee chairman Rep. Robert Sprague (R-Findlay) praised the field hearing for offering him and his colleagues "a wide cross-section of opinions and experiences with this issue, which will assist the Ohio House in more effectively addressing the problem of prescription drug abuse."
Unintentional drug overdoses have been the leading cause of accidental deaths among Ohioans since 2007, two-thirds of which involve prescription opiates.
Fellow committee member Rep. Lynn Wachtmann (R-Napoleon), who also chairs the House's Health & Aging Committee, added that although tackling Ohio's drug issue will be a "long fight...it is a fight that deserves our continued attention and diligence."
According to Ohio Department of Mental Health and Addiction Services Medical Director Dr. Mark Hurst, addiction is a "brain disease," as addictive drugs mimic neurotransmitter system activities and "trick" individuals into believing they are necessary for survival.
Like other chronic illnesses, addiction has both biological and behavioral components that need to be addressed, he said. Recovery is a long-term process and relapses can occur during or after treatment - signaling treatment adjustments or reinstatement.
Because of this, Mr. Hurst said, participating in support programs during and after treatment can help sustain long-term recovery. He also emphasized that "treating a biobehavioral disorder like addiction must go beyond just medication - we need to treat the whole person."
This type of holistic approach addresses behavioral therapies, social services, medical services and medication treatments, like naltrexone, methadone and buprenorphine.
Also offering input to the study committee, Rep. Mike Sheehy (D-Toledo) testified that local law enforcement and health care officials attribute the widespread abuse of these drugs, in part, to their "easy availability."
As a lawmaker representing the Toledo-area, he said he would lend his personal knowledge of the issue in his district to his colleagues in the General Assembly.
Kimberly Anderson, of the State Medical Board of Ohio, praised current efforts to regulate the licensures, inspections and operations of pain management clinics in Ohio during her testimony. This regulation, she said, is responsible for the ongoing decrease in unlicensed prescription dispensaries, or "pill mills."
Ms. Anderson also called for continued attention to any potentially troubling patterns in the prescribing of controlled substances, which have been made possible through collaborations with local law enforcement and the Governor's Cabinet Opiate Action Team.
The Medical Board has already adopted new prescribing guidelines that carefully monitor dosages prescribed for Ohio's patients, she added.
Kyle Parker, executive director of the Ohio State Board of Pharmacy, applauded the call for increased collaborative efforts with local law enforcement, but said illegal pain management facilities can be shut down more efficiently due to licensing changes and how discoveries of suspicious prescription activity is handled.
Recent enhancements made to the Ohio Automated Prescription Reporting System require pharmacies to more frequently submit data regarding the movement of controlled substances through their facilities. Mr. Parker said this lets officials more accurately oversee how often and in what quantity these products are dispensed.
Now that administrative licensure is reviewed by organizations like the board, he added, authorities representing the groups that oversee pain management clinics can vote to suspend activities in pain management office locations immediately if illegal activity is suspected.
"Previously we had to address these physicians via the criminal legal path, which took a very long time, sometimes years to have enough of a case to get these to trial," he said in written testimony.
Director of Physician Hospital Relations with the Ohio State Medical Association Jeff Smith also praised the OARRS enhancements and urged that changes to prescribing processes, professional educational initiatives and the formation of more resources for prescribers are key to combatting the drug abuse problem in Ohio.
The OSMA is committed to advocating for these new monitoring programs, as well as developing more tools for pharmacies and medical organizations to use to better regulate use of these substances and implement additional clinical and public education, he said in testimony.
Public education about drug abuse needs to have a solid evidence-based approach, Marcie Seidel, executive director of Drug Free Action Alliance said.
Ms. Seidel called for a statewide effort to build more drug abuse prevention and awareness campaigns, citing such initiatives for past success in bringing about change.
"Let's look at the tobacco prevention campaign as an example: currently, tobacco use is at an all-time low with more youth smoking marijuana than tobacco," she said. "Every tool in the prevention tool box was used to create this public health shift.
"This didn't happen overnight, but the steady approach on the national level, state-level and in communities made the difference."
Increased community attention to the problem, such as support and funding for prevention activities, has already made an impact in many parts of Ohio, Scott Sylak, executive director of the Mental Health and Recovery Services Board of Lucas County said in testimony.
He also advocated for the expansion and overhaul of the state's Medicaid system as "a viable option to ensure access to health care for Ohio's working poor and uninsured citizens."
Mr. Sylak added that using Medicaid for this purpose could cut overall healthcare costs for low-income individuals statewide, maintain better safety and security in Ohio communities and also keep potential employees for local businesses healthier.
Dr. Howard Stein, Director of the Neonatal Intensive Care Unit at the ProMedica Toledo Children's Hospital said at the hearing, meanwhile, said cases of Neonatal Abstinence Syndrome (NAS), or newborns who experience physiological withdrawal symptoms due to drug use during pregnancy, have seen a huge recent increase in the U.S.
Following pledges by Gov. Kasich to Ohio's children's hospitals for collaborative research, Ohio must continue to develop infrastructure and review data regarding these new trends in order to better understand, identify, and treat affected infants, Mr. Stein said.
Dr. Neeraj Kanwal, vice president of medical affairs at ProMedica Toledo Hospital, reiterated the rise in concern about and prevalence of drug abuse and its health impacts in Ohio at the state's hospitals.
"We see the impact of opiate abuse every day in our hospital. Treating pain and relieving suffering is a medical priority and no place feels this impact more than the emergency department," he said. "Opiod and other prescription misuse blurs the lines for care."
Echoing the need for a more complete approach to drug abuse treatment, Ernest Boyd, executive director of the Ohio Pharmacists Association said OPA, in cooperation with the Bureau of Workers Compensation, is on the cusp of unveiling a medication therapy management program for narcotics and other pain medications use.
In his testimony he stressed OPA is eager to begin this initiative and confident that the strategy will yield positive results.
Mr. Boyd also expressed the importance of ensuring that continuing efforts to fight Ohio's drug abuse epidemic not negatively interfere with the treatment of the state's patients.
"We are dedicated to assisting in the fight to stop addiction, and the overuse of these medications, but we must also not cause harm to our patients. It's a challenging position to be in," he said.
The committee will wrap-up its road hearings at Lutheran Hospital in Cleveland on September 12 at 1:00 p.m.