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Opioid Abuse Declared Statewide Health Emergency

Governor McMaster Issues Directive to Limit Opioid Prescriptions

On Monday, December 18, 2017, Governor Henry McMaster declared the opioid crisis a statewide public health emergency, and issued two Executive Orders focused upon combating the Opioid epidemic in South Carolina.

The Authority to issue a statewide health emergency is set forth in S.C. Code Ann. §§ 44-4-130(P),(R) and S.C. Code Ann §  1-3-420,  which provide that a statewide health emergency may be declared when the governor opines that a qualifying health condition poses a substantial risk of a significant number of human fatalities.

Prescription pain medication specifically noted as associated with the epidemic included hydrocodone, oxycodone, codeine, morphine, heroin, and analogs of the synthetic opioid analgesic fentanyl, including carfentanyl.

The reported statistics are staggering:

  • In 2016, death certificates reflected 684 deaths attributed to prescription drugs in South Carolina, just shy of a 20% increase from 2014.
  • Deaths attributable to heroin increased 67% from 2014 to 2015, further increasing by 14% from 2015 to 2016.
  • The number of Opioid overdose deaths nearly doubled the number of homicides in 2016 

The Opioid Emergency Response Team

Executive Order 2017-42 provides for the creation of an Opioid Emergency Response Team, created to effectively coordinate federal, state and local resources, and to ensure coordination and collaboration among government agencies, private entities, and associations, and state and local law enforcement.  The team, which is comprised of state and federal enforcement agencies, state health regulatory agencies, including a representative from the South Carolina Department of Labor, Licensing and Regulation (LLR) and the South Carolina Department of Health and Environmental Control (DHEC), and health care treatment providers, will be tasked with drafting an Opioid Abuse State Plan by June 2018 with a list of action items. Other tasks include recommending ways to strengthen the current Prescription Drug Monitoring Program (SCRIPTS). 

McMaster further noted the recently issued Joint Revised Pain Management guidelines, which we discussed here, advising that “[n]othing in this Executive Order is intended to invade the practitioner-patient relationship or intrude into the prescriber’s area of expertise.  The purpose of the Executive Order is to limit the scope of acute and post-operative situations to prevent the initiation of dependency and addiction.”   

Opioid Prescriptions for Medicaid Recipients Cut

Executive Order 2017-43 further directs the South Carolina Department of Health and Human Services to limit opioid prescriptions for acute and post-operative pain to a maximum of five days for state Medicaid recipients.  According to a press release issued by the Governor, The State Public Employee Benefit Authority (PEBA), the largest Group plan in South Carolina, has agreed to enact a limit for all State Health Plan participants. Governor McMaster further implored the State General Assembly to pass legislation limiting all initial opioid prescriptions to five days.

Although the Order acknowledges that it does not intend to invade the practitioner-patient relationship, a licensee with prescriptive authority to write Schedule II pain medications should proceed with caution in light of the recently issued Executive Orders.  Practitioners, including physicians and dentists, should ensure that the risks and benefits of Opioids are discussed and documented, that alternatives are explored, and that the lowest dose possible is prescribed for the shortest amount of time.  With the declaration will likely come increased monitoring of Schedule II medication administration. Nurses who administer Schedule II pain medication should ensure that each patient is properly accessed, the rights of medication are followed, and that any waste is witnessed and promptly disposed of.  In short, a licensee’s best defense in the event that his or her practice is called into question may be proper documentation.

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