Family urges NC to put limits on opioid prescriptions

A doctor prescribed pain medication when Drew Gintis hurt his shoulder during a high school wrestling match, but the pills couldn’t fix the loss he felt inside.

Gintis had been a captain of the wrestling team at Athens Drive High School, where he graduated in 2012. The injury pushed him to the sidelines his senior year.

“It killed all his desire when he couldn’t wrestle,” said Warren Gintis, Drew’s father.

“He lost his identity,” added his mother, Marsha Gintis.

The Cary couple soon noticed some of their own painkillers from recent surgeries were missing. At some point, they say, their son started using heroin.

Drew Gintis died of a drug overdose in his Florida apartment on July 31, 2015, at age 21. His parents say his body was found near a stimulant known as bath salts and fentanyl, a pain medication more potent than heroin and morphine.

Now the Gintis family is urging North Carolinians to contact their representatives in the state General Assembly in support of the Strengthen Opioid Misuse Prevention Act, also known as STOP, which aims to reduce the free-flow of prescription opioids in the state. The bill is set to go before a state health committee Wednesday.

If it becomes law, the STOP Act will forbid doctors from prescribing more than a five-day supply of opioids such as Percocet during an initial consultation to treat a patient’s acute pain, such as from a broken arm. Doctors could prescribe a bigger supply during follow-up visits, and the limit would not apply to cancer patients and others being treated for chronic pain.

Medical providers would also be required to submit prescriptions for controlled substances electronically and participate in North Carolina’s existing reporting system that aims to prevent “doctor shopping.”

Many people see the bill as a way to curb the rising number of overdose deaths in North Carolina, and it has gained bipartisan support. Several statewide groups support the bill, including the N.C. Medical Board, the N.C. Sheriffs’ Association and the N.C. Association of Chiefs of Police.

The bill is one response to what politicians and health officials describe as a growing opioid crisis in the country. In 1999, 150 people in North Carolina died of overdoses of heroin and other opioid drugs; by 2015, the number had climbed to 1,110. Opioids are widely considered a gateway drug to heroin.

Some states, including Washington, Connecticut and New York, have already passed laws that put limits on prescribing pain medication. Rep. Greg Murphy, a Pitt County Republican and surgeon who is co-sponsoring the STOP Act, said it’s time for North Carolina lawmakers to put tougher rules in place.

“It is the No. 1 health crisis facing our state,” Murphy said.

Reporting system

The N.C. Controlled Substance Reporting System was set up in 2005 and is run by the N.C. Department of Health and Human Services.

Doctors can use a code to enter the online system and log opioid prescriptions and check a patient’s history of other opioid use. Pharmacists can also use the system to track a patient’s history.

But doctors and pharmacists aren’t required to use the system, so there can be gaps in the data. Under the STOP Act, they would be required to use it through a three-year roll-out.

“There are lots of physicians who aren’t signed up,” said Dr. Robyn Jordan, who treats opioid patients through UNC Hospitals and supports the legislation. “That’s what this bill is about – everyone should be using this system.”

Under the bill, pharmacists would have to report in the system within 24 hours of dispensing an opioid prescription. The current system, Jordan said, can have a three-month delay, making it tough to gauge whether patients are being prescribed too much pain medication.

Jordan said requiring medical providers to prescribe pain medications electronically will make the process more secure and prevent the possibility that a doctor’s prescription pad gets stolen and used.

“That’s where a lot of the fraud goes on,” Murphy said.

Challenges

Jay Campbell, executive director of the N.C. Board of Pharmacy, said his organization worries the STOP Act would create barriers for patients who legitimately need pain medication. He said the bill needs to make a clear distinction between acute pain and chronic pain so pharmacists don’t have to “play detective” to determine whether a customer is misusing opioid prescription drugs.

“It’s a useful tool,” Campbell said of the reporting system. “It’s certainly not a silver bullet.”

A provision in the bill that calls for tightening rules for nurse practitioners and physician assistants has also drawn criticism.

Under the STOP Act, nurse practitioners and physician assistants would be required to consult with a supervising physician before prescribing more than a 30-day supply of pain medication for patients with chronic pain.

Some of these medical providers aren’t in the same county as their supervising doctor, so it would take time for a consultation to take place, said Bobby Lowery, education and advanced practice nursing consultant with the N.C. Board of Nursing. That means patients could be responsible for more co-pays if they have to return to the office.

“It will delay care, there’s no question about that,” Lowery said.

There could be other challenges, too. Not all medical providers have the technology to submit prescriptions electronically. Currently, Jordan said, UNC Hospitals doesn’t have a system in place to prescribe opioids electronically.

An earlier version of the bill called for the state to set aside $20 million for community health services to help patients addicted to opioids. But the provision was pulled after discussions with budget leaders, Murphy said. It could be included in other legislation.

Mark Ezzell, executive director of Addiction Professionals of North Carolina, said he thinks more people would seek treatment if the bill passes, so it would be important to ramp up public health clinics.

Many heroin addicts first got hooked on pain medication, he said, so limiting the number of opioids could help break the cycle.

“If we curb that, it’s going to make a huge difference,” Ezzell said. “I think this is a very, very important first step ... that everyone can support.”

‘The jokester’

The Gintis family doesn’t want anyone else to go through what they experienced with their son.

Warren Gintis, a veterinarian and president of Swift Creek Animal Hospital in Raleigh, said it’s crucial for doctors to know if patients are being prescribed too much pain medication.

Growing up, Drew Gintis was a happy kid who enjoyed hanging out at the skate park.

“He was the jokester,” Marsha Gintis said. “He was the one who made people laugh, had a smile on his face.”

Drew’s older sister, Haley, encouraged him to try a sport at Athens Drive High School. His freshman year, he won only one wrestling match – a forfeit.

Instead of giving up, he went to wrestling camps and started winning matches. He was named captain of the team his junior year.

“When he wanted to do something, he went all out,” Marsha Gintis said.

A year before he died, Drew attended an eight-week nature-based drug rehabilitation program in Utah. Then he went to a rehab center in California.

The programs didn’t help much, Warren and Marsha Gintis said.

In April 2015, Drew moved to Florida with a friend. He seemed to be doing well for a while and had a job at a Petco store.

But when his parents went to visit Drew a few months later, they suspected he had relapsed. They were about to call him from their hotel when the phone rang. It was the police.

“Marsha kept saying, ‘Is he alive? Is he alive?’ ” Warren Gintis said. “(The officer) finally said no, and Marsha kind of threw me the phone.”

Less than a week later, they buried their only son.

This story was originally published March 28, 2017 at 3:11 PM with the headline "Family urges NC to put limits on opioid prescriptions."