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Gov. Malloy Receives Strategic Plan on Battling the Opioid Epidemic

(HARTFORD, CT) - Governor Dannel P. Malloy today received the final report and strategic plan on fighting the opioid epidemic that he commissioned earlier this summer in an effort to develop a succinct, prioritized, three-year strategy on behalf of the State of Connecticut that will help further prevent addiction and overdoses, which states around the country have experienced an increase in over the last several years.

The genesis of the strategic plan was Governor Malloy's charge to the Alcohol and Drug Policy Council (ADPC), a statewide stakeholder group, to comprehensively address Connecticut's opioid crisis. The Governor also engaged the Connecticut Opioid Response (CORE) team, led by Dr. David Fiellin from the Yale University School of Medicine, and including Dr. Robert Heimer, Dr. William Becker, and Dr. Gail D'Onofrio, to supplement and support the work of the ADPC by creating a focused plan that can reduce the number of opioid deaths in Connecticut. The two groups were asked to develop strategies that emphasize initiatives to prevent and treat addiction based on evidence, public input, and judgment about where efforts can have the most impact.

"Connecticut is taking action on this nationwide epidemic, and these important plans presented to us today will expand our toolbox and guide the fight against the epidemic of opioid addiction and overdose," Governor Malloy said. "Addiction is a disease, and together we can treat and prevent it. Our work on this is not finished until our communities and our families are no longer struggling with the grave costs of this illness. Thank you to all of our partners, including the Yale School of Medicine and our private insurance carriers, who have chosen to be leaders on this issue and come together as a community to help combat this crisis."

"I thank Dr. Fiellin and his team for their work on this report," Lt. Governor Nancy Wyman said. "Having a deeper understanding of addiction and prevention is key to combatting opioid misuse, and it's part of a bigger strategy to ensure our residents can live healthier, more productive lives. These recommendations will drive important discussions and help save lives."

Some of the recommendations presented to the Governor in the Connecticut Opioid REsponse (CORE) Initiative include:

  • Increase access to high-quality treatment with methadone and buprenorphine:
    • Strategically expand opioid treatment programs in areas of high need
    • Promote same-day treatment
  • Reduce overdose risk, especially among those individuals in highest danger:
    • High-risk individuals include those who have previously overdosed, those leaving prison or treatment, those taking both opioids and benzodiazepines, and those using injection opioids
    • Intervene in the emergency room to get those who have overdosed into treatment
    • Distribute naloxone to those who are at high-risk of overdosing
    • Decrease co-prescription of opioids and benzodiazepines and high doses of opioids
  • Increase adherence to opioid prescribing guidelines, especially for prescribers who prescribe large amounts of opioids:
    • Increase use of non-opioid treatments for acute and chronic pain
    • Increase use of the prescription monitoring program
    • Expand professional trainings on screening, brief intervention and referral to treatment for adult and adolescent patients
  • Increase access to and track the use of naloxone
  • Increase data sharing across relevant agencies to coordinate response, especially in response to "outbreaks" of overdoses
  • Increase community understanding of opioid use disorder, the most effective and evidence-based responses to it and reduce stigma around it
  • Develop communications strategies that raise awareness and promote education on safe storage and disposal of prescription drugs

"The CORE Initiative will help state stakeholders focus their efforts on strategies that are expected to have the largest and most immediate impact on the opioid epidemic," Dr. Fiellin said. "This involves rapid dissemination and implementation efforts to dramatically increase the use of proven life-saving strategies that are advocated by entities including the White House, the Surgeon General and the World Health Organization."

Dr. Heimer said, "At the Governor's behest, we developed a plan to curtail the misuse of opioids and reduce the number of opioid overdose deaths. We have identified broad strategies and specific tactics that are based on an understanding of the science of addiction and evidence of their practical utility. We also have included metrics that will allow us to determine those elements of our plan that are effective and those that will need to be improved."

Connecticut's health insurance carriers have also been a partner in developing the strategy.

Keith Stover, a spokesman for the Connecticut Association of Health Plans, said, "Connecticut's health insurers were pleased to support the initiative undertaken by Dr. Fiellin and his Yale colleagues that resulted in today's announcement. We look forward to working with the Governor, his administration and the General Assembly in addressing this critical issue."

The report from the CORE initiative complements a series of recommendations on the topic from the ADPC.

"The CORE recommendations along with those of the Alcohol and Drug Policy Council provide a framework for addressing the opioid epidemic in Connecticut. While much is already being done within the state, these recommendations will further the state's efforts to reduce opioid addiction and overdoses," Connecticut Department of Mental Health and Addiction Services Commissioner Dr. Miriam Delphin-Rittmon said.

"Substance use has long impacted children and families and the discussion around opioids is the most current issue in a sadly long history of substance use. The Department of Children and Families unfortunately sees firsthand the impact that substance use can have on children and families. It is incumbent on all of us to have a proactive system that emphasizes prevention, creates access to treatment and supports recovery in all forms," Department of Children and Families Commissioner Joette Katz said. "Already, in the short time since the Alcohol and Drug Policy Council was reconstituted, a set of thoughtful recommendations has been put forth designed to improve systems and outcomes for youth, families and communities."

"I would like to thank Governor Malloy for his leadership on this critical public health issue," Connecticut Department of Public Health Commissioner Dr. Raul Pino said. "We are very proud to partner with our sister agencies, DMHAS and DCP, and the community at large to stem the tide of opioid overdoses. I look forward to reading the CORE report and strategic plan and discussing with our partners how we can use the report as a road map to strengthen our current efforts to combat this epidemic."

The Governor has directed his office and the relevant state agencies to review the report over the next several weeks and return to him with proposed actions the state can take so that the state's resources are used in the most effective manner possible to implement these recommendations.

Since taking office, Governor Malloy has enacted several policy changes to combat the opioid epidemic. These include:

  • the 2011 adoption of Good Samaritan laws protecting individuals from prosecution for minor drug crimes who seek medical attention for a friend experiencing an overdose (Public Act 11-210);
  • the 2012 adoption of third party prescriber laws allowing the prescription of naloxone to an individual who is not the direct user of the drug (Public Act 12-159);
  • the 2014 expansion of Good Samaritan protections for any person who, in good faith, administers naloxone to save a life. Previously, only licensed health care practitioners were allowed to administer the medication without being civilly or criminally liable for the action. Following the law's adoption, all Connecticut State Police Troopers completed a training program providing them with the skills to administer the medication. (Public Act 14-61);
  • the 2015 adoption of legislation that expanded prescriber education, made use of the Prescription Monitoring Program (PMP) mandatory for all prescribers of controlled substances, expanded the scope of practice for pharmacists to allow them to directly prescribe naloxone and reconstituted the Alcohol and Drug Policy Council (ADPC) as a statewide coordinating body to fight the spread of substance abuse and overdose (Public Act 15-198); and
  • the 2016 legislative package that, among other things, limits the prescribing of opioid drugs to seven days (with certain exceptions), and requires municipalities to update their medical service plans to ensure first responders are equipped with Narcan (Public Act 16-43).

**Download: Strategic plan of the Connecticut Opioid REsponse (CORE) Initiative
**Download: Recommendations of the Alcohol and Drug Policy Council (ADPC)

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David Bednarz
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