Current Health Care Legislation
Ghadeer G. Ibrahim
Submitted in partial fulfillment of the requirements for
NURS 510: Health Care Delivery Systems:
Political, Social and Economic Influences
Shepherd University
Department of Nursing Education
September 5, 2017
I chose to discuss Maryland House Bill 1082-entitled Heroin and Opioid Education and Community Action Act of 2017 (Start Talking Maryland Act). This bill requires Maryland public schools to incorporate heroin and opioids in their drug addiction and prevention programs, institute policies regarding the storage and administration of naloxone and to achieve this requirement, local boards of education or local health departments (LHD) may hire a county or regional community action official or develop such program. Moreover, the bill entails the appropriation of three million dollars to the Maryland State Department of Education (MSDE) in fiscal 2019 to fund the bill’s necessities including training and policies. The bill requires institutions of higher education in Maryland, that receive funding from the state, to develop policies regarding the education of students on heroin and opioid addiction and prevention, on obtaining and storing naloxone, and on the training of designated personnel. In addition, certain institutions of higher education will be required to offer instruction in substance use disorders. Lastly, MSDE will be obligated to assemble a workgroup that will submit a report on behavioral and substance abuse disorder services in public schools to the General Assembly (Start Talking Maryland Act, 2017).
Delegate Eric M. Bromwell introduced House Bill 1082 on February 9, 2017. On that day it was read for the first time and assigned to the House Health and Government Operations Committee. On April 4, 2017, the bill passed its third reading by the House Health and Government Operations Committee with all members supporting the bill as it was favored with amendments. On the following day, the bill was read by the senate and referred to Education, Health, and Environmental Affairs committee. Less than a week later, the bill was read three times by the Senate and passed with amendments. Upon passing it returned to the House where it passed again after the amendments were considered. The bill enrolled on April 10, 2017, and the Governor approved it on May 25, 2017, with an effective date of July 1, 2017 (Start Talking Maryland Act, 2017).
Rudd, Seth, David, and Scholl (2016) reported that death rate across from opioids including fentanyl in 2015 increased by 72.2% from the previous year and death rate from heroin increased by 20.6%. The authors note that in 2015 there were 52,404 deaths in the United States related to drug overdoses, and 33,091 or 63.1% of these deaths involved an opioid. In an effort to reduce the deaths related to opioid use, Rudd, et al. conclude by recommending improvement of prescription drug and monitoring programs, enhancement of access to treatment including access to naloxone, and implementing means of decreasing harm that may be imposed on individuals with opioid use disorders such as syringe services.
Governor Larry Hogan declared a state of emergency related to heroin, opioid, and fentanyl on March 1, 2017, in the state of Maryland. During that time it was announced new funding of fifty million dollars, over a five-year period, in order to assist with solving the crisis (Maryland Department of Health, 2017). To aid with this crisis starting June 1, 2017, Maryland Department of Health and Mental Hygiene (DHMH) issued a statewide standing order for naloxone, explaining that any person will be able to access and obtain the medication at a Maryland pharmacy without needing a prescription. DHMH, (2017) identified naloxone as “a life-saving medication that can quickly restore the breathing of a person experiencing an opioid overdose.”
According to Analysis, House Bill 1082 of 2017 public schools must contain not only teaching related to heroin and opioid addiction and prevention in their program but also teaching related to the fatal outcome of fentanyl. The teaching must be provided to children starting in third grade and ending in twelfth grade. Adding to that, the teaching needs to be provided as a stand-alone unit in the program by trained teachers. The Analysis of Start Talking Maryland Act of 2017 also mentions that local boards of education have to approve a school nurse, health service personnel, or other school personnel to administer overdose reversing medication or naloxone to an individual who is believed to be experiencing an opioid overdose. The bill protects the individual who administers treatment in response to an emergency from personal liability if the individual responds in good faith. The Analysis furthermore mentions that the grants authorized by the governor must be dispersed to the schools by MSDE in fiscal year 2019 budget based on student enrollment count of the previous year. However the local boards must start the bill implementation process prior to receiving funds. Each school has to submit reports to MSDE for each episode in which naloxone or other overdose reversing medication was used on a form specified by MSDE. In turn MSDE is required to report the collected information to the General Assembly for three consecutive years starting with 2018.
Institutes of higher education that receive state funding must develop policies on heroin addiction and prevention which will require incoming students who attend the institution on a full-time basis to partake in in-person awareness training, and if in-person training is unfeasible the student has to receive training electronically. Moreover, resources should be provided for students who attend on a part-time basis. Institutions have to stock naloxone or other overdose reversing medication and they have to train campus police or other selected personnel on recognizing symptoms of overdose, administering medications, and following-up on emergency events. Similar to MSDE the institutions of higher education are also required to submit reports for each episode that naloxone or another overdose reversing medication was administered to the Maryland Higher Education Commission (MHEC) and in turn MHEC will report the information to the General Assembly for three consecutive years starting with 2018. The Analysis of HB 1082 (2017) also add that if an institute of higher education offers individuals a degree that meets education requirements and state licensure as a physician, physician assistance, advanced practice nurse, podiatrist, or dentist, then the institution must offer education on substance use disorders, treatment and pain management.
An article by Lewis, Park, Vail, Stine, Welsh, and Sherman (2016) discussed Maryland’s first community-based state authorized training program, overdose education and naloxone distribution (OEND), lead by the volunteer driven Baltimore Student Harm Reduction Coalition (BSHRC). This OEND program provided training to individuals 18 years or older, in compliance with the curriculum mandated by the State of Maryland, on how to recognize and react to overdose. Out of 285 participants, three successful overdose reversals were reported.
Another article by Wheeler, Jones, Gilbert, and Davidson (2014) discusses providing naloxone to laypersons as part of the opioid overdose reduction programs. The authors explain that providing naloxone to laypersons reduces deaths related to overdose, it is safe and cost-effective. They recommend providing the treatment to individuals who may observe overdose or who may experience it like patients in substance abuse treatment programs. However Davis, Green, and Beletsky (2017) mention that in 2013 only 11% of Americans were able to access treatment when they needed it due to availability, cost, and legal concerns.
I believe that the Start Talking Maryland Act will have a positive impact on health care through the increased awareness that it will bring to the community especially that it is targeting children and young adults. Education is very important in this crisis that the nation is facing. As a nurse who is newly researching this subject, I feel that I am obligated to learn more about this topic that I have not received in-depth education about. I believe that access to naloxone in Maryland will improve with current changes in the legislation.
References
Davis, C., Green, T., & Beletsky, L. (2017). Action, Not Rhetoric, Needed to Reverse the Opioid Overdose Epidemic. The Journal of Law, Medicine & Ethics , 20-23. Doi:10.1177/1073110517703310
Heroin and Opioid Education and Community Action Act of 2017 (Start TalkingMaryland Act). (2017). Department of Legislative Services. HB 1082, MD (2017)
Lewis, D. A., Park, J. N., Vail, L., Stine, M., Welsh, C., & Sherman, S. G. (2016). Evaluation of the Overdose Education and Naloxone Distribution Program of the Baltimore Student Harm Reduction Coalititon. American Journal of Public Health Prctice , 1243-1246. Doi: 10.2105/AJPH.2016.303141.
Maryland Department of Health . (2017). Overdose Prevention in Maryland . Retrieved September 1, 2017, from Behavioral Health Administration: https://bha.health.maryland.gov/OVERDOSE_PREVENTION/Pages/Index.aspx
Maryland Department of Health and Mental Hygiene. (2017). bha.health.maryland.gov. Retrieved September 01, 2017, from www.dhmh.maryland.gov: https://bha.health.maryland.gov/NALOXONE/Pages/Naloxone.aspx
Rudd, R. A., Seth, P., David, F., & Scholl, L. (2016). Increases in Drug and Opioid-Involved Overdose Deaths – United States 2010-2015. Morbidity and Mortality Weekly Report , 65 (50&51), 1445-1452. doi:http://dx.doi.org/10.15585/mmwr.mm655051e1.
Wheeler, E., Jones, S., Gilbert, K. M., & Davidson, P. J. (2014). Opioid Overdose Prevention Programs Providing Naxolone to Laypersons. United States: MMWR: Morbidity & Mortality Weekly Report .