Newtown responders and officials who have seen the devastation resulting from Connecticut's opioid epidemic are hailing newly enacted legislation that limits prescription quantities on powerful painkillers, mandates towns and cities to provide an overdose reversing drug to emergency responders, and enhances an electronic prescription monitoring system that could foil addicts who are "doctor shopping" to stockpile opioid medications.Comment On COREState, Local ReactionsLocally, Lives SavedHistory Of Response

On May 27, Governor Dannel Malloy signed legislation that he introduced in collaboration with several members of the General Assembly, expanding the state's effort to combat the opioid epidemic. Four days later, Newtown First Selectman Pat Llodra issued a statement for residents of Newtown highlighting Gov Malloy's announcement and the Connecticut Opioid Response Initiative (CORE).

"This bill builds upon our past efforts that we have made to prevent drug abuse and addition, to educate the public about the dangers of prescription drug misuse and to save the lives of those who suffer from addiction," Gov Malloy said. "These are critical steps forward."

The legislation, Public Act 16-43, is comprehensive in nature and incorporates several provisions, including limiting the prescription of opioid drugs by:

*Prohibiting, for adult patients, an initial prescription of opioid drugs for longer than seven days;

*Prohibiting, for minor patients, any prescriptions of opioid drugs for longer than seven days and requiring the prescriber to discuss the risks associated with the drug with the patient and, if present, the custodial parent, guardian or other person having legal custody of the patient;

*Allowing, for both adult and minor patients, a prescriber to give more than a seven-day supply of opioid drugs if, in the prescriber's professional medical judgment, the acute or chronic pain condition requires it and requires the prescriber to note such condition in the medical record;

*Requiring municipalities to update their existing emergency medical services plans to ensure that the emergency responder likely to the first person on the scene of an emergency call is equipped with and prepared to administer the overdose reversal drug naloxone and has been appropriately trained to do so;

*Closing a gap in current liability language related to a licensed health care professional who administers an opioid antagonist;

*Prohibiting commercial health carriers from requiring prior authorization for coverage of naloxone;

*Requiring the Alcohol and Drug Policy Council's state plan to include, by January 1, 2017, a goal of reducing the number of opioid-induced deaths in the state;

*Making several changes to the state's electronic prescription monitoring program to help facilitate prescriber and pharmacist compliance.

Gov Malloy also announced the creation of a partnership between his office, the Yale School of Medicine and Connecticut's insurance carriers to develop a strategic plan to guide the state's response to the epidemic. Led by Dr David Fiellin of Yale, this effort will be shaped by addiction experts and state agency leaders, and will include input from local and national experts, as well as the general public.

The group will be responsible for developing a succinct, prioritized, three-year strategy for the state on opioid addiction and overdoses. It will emphasize strategic initiatives to prevent and treat addiction based on evidence, public input and judgment about where efforts can have the most impact.

On May 31, Mrs Llodra called on residents to provide feedback on their experiences during an open public comment period regarding the Connecticut Opioid Response (CORE) Initiative.

"Public comment and insight will be crucial to the final plan," Mrs Llodra said. "The CORE initiative team will be gathering that input and incorporating it into their final plan through two avenues."

Residents are encouraged to send an e-mail to CTopioidplan@yale.edu or visit plan4children.org/core.

"We encourage anyone who has been affected by opioid addiction and overdose in Connecticut in any way to share their experience, their constructive feedback and their suggestions for the CORE team," Mrs Llodra said. "Information submitted via e-mail and the online form will go to the same place.

The general public comment period for the draft will end on June 30. The draft plan will be posted in July, with another period for feedback that will conclude at the end of July, according to the CORE website.

"Please also be aware that the CORE team is only collecting feedback for the strategic plan," Mrs Llodra said. "Anyone seeking resources or help for a prescription opioid or heroin addiction should call 800-563-4086 or visit portal.ct.gov/governor/substance-abuse."

Commissioner Joette Katz of the Department of Children and Families said Connecticut children have been among those most severely affected by the opioid epidemic.

"The majority of children who enter state care come from families with a substance use disorder, and the rapid rise in opioid addiction is cause for real alarm," she explained. "This legislation and the collaboration between the state, Yale and the insurance industry is a big step forward to address this menace."

Newtown Health District Director Donna Culbert - who was just elected co-chair of the local Prevention Council along with Police Chief James Viadero - is among many who have had either a friend or loved one caught in the grip of opioid addiction. And she agrees with DCF Commissioner Katz that this legislation and the collaboration between the state, Yale and the insurance industry "is a big step forward to address this menace."

"This legislation will support prevention by hitting it at the source for many, at the prescription drug stage," Ms Culbert said. "The limitations on the amount of opioid drugs prescribed and the accounting of its use and related professional decisionmaking can impact rampant use and abuse."

The health director was also happy to see the legislation addressing some of the legal and insurance issues that have lingered for those who are trying to assist a patient or victim. She believes including the goal of reducing opioid-induced deaths in the state, in the Alcohol and Drug Policy Council's state plan by January 2017, engages a dynamic body with a cross section of members invested in the goal and able to work towards measurable outcomes.

"In addition, the newly created partnership will expand the collaboration of the various partners and will allow working outside of the silos that often contain great work but limit the distance the impact can travel," she said. "There is a need for collaboration among the ranks of people, organizations and agencies; so many are desperate to change this landscape, we need to work together so the energy and the limited resources help the most people, across the most geography."

Ms Culbert said Mrs Llodra's call to the Newtown community to provide input is vitally important.

"Residents' experiences shared with the CORE team will help in the formation of a response," Ms Culbert said. "Data is critically important when assessing a problem and looking at possible interventions and solutions. However, personal experiences can inform in a way that goes beyond data. This effort needs both, and then some."

Chief Viadero could not agree more.

"As a [police] chief I am very happy with the bill," he said. "It provides first responders with legal protection to administer Narcan [naloxone]. Our officers have been trained in its use and it was deployed in February to all our patrol units. We have since administered it two times for successful saves in overdose cases."

In addition, Newtown police officers have been actively involved with the Board of Education and Prevention Council in providing training for parents and educators at several forums. This training focused on detection, awareness and current trends.

"The legislation passed is a step in the right direction and addresses some of the major concerns that have been confronting those who have been battling the issue of overprescribing opioid-based drugs," Chief Viadero added. "Additionally the educational component as well as treatment alternatives are essential to a multifaceted approach to the problem. Law enforcement officials have long been in agreement that we cannot arrest ourselves out of this problem. The solution has to be a partnership among [professionals of] many disciplines."

Newtown resident William Begg, MD, is vice chairman of emergency medicine at Danbury and New Milford Hospitals. As someone who has seen the explosion of opioid overdoses and of those seeking an opioid fix flood into his emergency rooms in recent years, he believes the new legislation is an important "next step" in facing and addressing some core issues contributing to the epidemic.

"For those who aren't aware, statistically today we are seeing more deaths from opioid overdose than from gun violence and motor vehicle crashes combined," Dr Begg said. "So we have to address this in Connecticut. These new laws are part of the natural progression of laws we've seen in the state as this epidemic continues getting worse."

The emergency physician said making the prescription monitoring website more "physician-friendly" will go far toward better tracking of individuals who may bounce from doctor to doctor - or ER to ER - trying to collect as many prescriptions as possible.

"And the fact that we'll have Narcan available without a prescription, along with having it available with all our emergency responders, is also very important," he said.

The latest opioid bill the governor signed May 27 builds upon several measures enacted into law over the last several years including:

*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 (Narcan) 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.

State Troopers have saved more than 60 lives to date by utilizing this law (Public Act 14-61).

The 2015 legislation that expanded prescriber education made use of the Prescription Monitoring Program (PMP) mandatory for all prescribers of controlled substances, and 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).

While there is no doubt that the public over-the-counter availability of naloxone holds as much life-saving potential as EpiPens used for allergic reactions to nuts and insect stings, Newtown Volunteer Ambulance Corps Chief Michael Collins implores any private citizen using the naloxone antidote to call for help any time a narcotic or opioid overdose is suspected.

"Narcan administered in a single dose to someone not having an opioid overdose will not hurt them, but it can counteract the respiratory depression that typically kills a person who has overdosed," Chief Collins said. "But it's critical to know that opiates can remain active in the body after the naloxone wears off. So any suspected overdose should receive immediate and trained emergency medical intervention, or the individual could still die from respiratory distress an hour or two later."

Even for seasoned public health professionals, Ms Culbert says its "hard to put your arms around how we got to this place, this epidemic."

"We can follow the path of it, the excessive use of pain killers and how readily available they are, and the economics of stepping up, or down, depending on how you look at it, to the cheaper heroin and then its ready availability," she said. "I remember growing up in the 60s and 70s and the 80s as a young adult, and it was ever so clear to me that heroin would ruin your life forever, even if you tried it once. So we knew it was a game changer, forever."

Of course, the health director acknowledges, the underlying circumstances were different.

"There was not the ubiquitous pill culture - that there was a pill for everything; nor was there such availability of painkillers and heroin," she said. "But even so, there was a different mindset. Why aren't people afraid of this stuff?"