This memorandum provides information on action taken to address the national opioid epidemic, including federal legislation, treatment options in Kansas, and strategies used by other states.
Background
Opioids are natural, synthetic, or semi-synthetic chemicals that interact with specific, opioid receptors on nerve cells in the body and brain1. This interaction reduces the intensity of pain. Commonly prescribed opioids include hydrocodone (Vicodin®), oxycodone (OxyContin®, Percocet®), oxymorphone (Opana®), morphine (Kadian®, Avinza®), and codeine (used in cough suppressants). Methadone, also a prescribed opioid, can be part of a medication-assisted treatment plan for opioid use disorder2. Similarly, the opioid fentanyl — which is used to treat severe pain because it is 100 times more potent than morphine — can be obtained with a prescription. Illegally obtained fentanyl is primarily manufactured in foreign, illicit labs and then smuggled into the United States. In this form, fentanyl is often mixed with other illicit drugs and made into pills to resemble prescription opioids3.
The increase in opioid overdose deaths in the United States due to any opioid can be outlined in three distinct waves. The initial, gradual increase started in the 1990s and was closely tied to a rise in commonly prescribed opioid medications. In the 2010s, a rapid increase of opioid overdose deaths was attributed to heroin specifically. Most recently, beginning in 2013, the data shows a rapid surge in opioid overdose deaths due to other synthetic opioids, including tramadol and fentanyl.
Data specific to Kansas mirrors the national trend. According to testimony provided to the House Committee on Corrections and Juvenile Justice in February 2023 by the Kansas Department of Health and Environment (KDHE) and the Kansas Department for Aging and Disability Services (KDADS), synthetic opioid overdose deaths have increased from 39 deaths reported in 2012 to 347 deaths in 2021, a 790 percent increase4. This increase is primarily seen in the last two years of available data: The number of deaths more than doubled both years, from 70 in 2019 to 161 in 2020, and then to 347 in 2021.
As of 2021, when taking into account age distribution and population size of a state, West Virginia has the highest drug overdose mortality rate, at 90.9 deaths per 100,000, followed by Louisiana, Tennessee, and Kentucky, at 55.9, 56.6, and 55.6 deaths per 100,000, respectively. Kansas is considerably lower, at 24.3 deaths per 100,000.
Federal Actions to Address Opioids
President Obama signed into law the Comprehensive Addiction and Recovery Act and appropriated funds to each of the 50 states through the 21st Century Cures Act. Several hundred bills have been introduced in the 115th Congress that address the opioid epidemic in some capacity. President Trump issued an executive order that created a national opioid commission, and Congress, through 2017 HR 244, appropriated $113.0 million to combat the opioid crisis.
Congress passed a spending package in December 2022 that removed the federal requirement for health care practitioners to have a waiver to prescribe medication for opioid use disorder, allowing practitioners to more easily prescribe buprenorphine and increasing access to treatment. Buprenorphine is the first medication to treat opioid use disorder that can be prescribed or dispensed in physician offices. It is an opioid partial agonist that produces effects of euphoria and respiratory depression at low to moderate doses. The effects of buprenorphine are weaker than those of full opioid agonists, such methadone. When taken as prescribed, buprenorphine diminishes withdrawal symptoms and physical dependency on opioids.
In March of 2023, the U.S. Food and Drug Administration (FDA) approved the first over-the-counter nalaxone nasal spray. (see “Nalaxone Access” below for more information on nalaxone.)
Addressing Opioids in Kansas
In 2017, Governor Brownback signed HB 2217 into law, amending the Kansas Pharmacy Act to allow first responders to carry nalaxone.
In 2021, the Kansas Legislature passed the Kansas Fights Addiction Act (HB 2079), which authorized the State to use money recovered through Kansas opioid settlements to tackle substance abuse and provide addiction services across the state. The settlement funds are split into two funds: 75 percent to the Kansas Fights Addiction fund, and 25 percent to the Municipalities Fight Addiction Fund (MFAF), with $200,000 dedicated annually to K-TRACS, the Kansas prescription drug monitoring program.
In October 2022, Governor Kelly announced that the State of Kansas and the Kickapoo Tribe in Kansas (KTIK), together, have received $17.2 million in federal grant funding to address the opioid crisis. The funding will be used by KDADS and KTIK through September 2024 to increase access to treatment for substance use disorders; remove barriers to public health interventions, such as naloxone; and expand access to recovery support services.
Kansas Opioid Treatment Programs
KDADS maintains a list of Kansas Opioid Treatment Programs. Programs are primarily located in eastern Kansas, including the Kansas City area, Lawrence, Overland Park, Topeka, and Wichita. The Substance Abuse and Mental Health Services Administration (SAMHSA) also maintains an Opioid Treatment Program Directory. According to SAMHSA, every state has at least one federally certified treatment location. However, the laws concerning the programs and requirements vary by state.
Medication-assisted treatment (MAT) works to normalize brain chemistry and body functions, block the euphoric effects of opioids, and relieve physiological cravings. Through September 2025, buprenorphine, methadone, and naltrexone are considered Medicare Part B MAT drugs for opioid treatment programs.
Kansas Prescription Drug and Opioid Advisory Committee
The Kansas Prescription Drug and Opioid Advisory Committee (Committee) was formally established in 2017. It is facilitated by DCCCA, Inc., and supported by KDADS and KDHE. The Committee is a multidisciplinary stakeholder group composed of state and local government, health systems, professional associations, community-based organizations, academic institutions, public safety and first responders, and others.
In December of 2022, the Committee released the second iteration of the Kansas Overdose Prevention Strategic Plan for 2022–2027. This plan was developed with contributions from the Committee, subject matter experts, and more than 55 organizations. The plan is centered on six overarching priorities:Treatment and Recovery, Linkages to Care, Prevention, Harm Reduction, Providers and Health Systems, and Public Safety and First Responders. These six priorities intersect across strategies, including data and surveillance; policy development, evaluation, and advocacy; stigma reduction; and health equity.
The objectives, strategies, and recommendations presented within each priority reflect best or promising practices, are driven by Kansas-specific data, and aim to address multiple levels of impact. Specific strategies are targeted to increase education and awareness, prevent substance misuse and use disorder, connect individuals who use drugs with substance abuse disorder treatment and wraparound services, scale up treatment services, advance harm reduction, and expand services for justice-involved populations. The full plan can be accessed here.
With the release of the current plan, the Committee also shared their progress on strategic indicators identified during the first iteration of the plan, which was 2018 to 2022.
Table 1. Previous Strategic Plan Indicators That Met or Exceeded 2022 Target Value5
| State-level Indicator | Baseline | Target | 2021 Value |
| Provider Education | |||
| Percent of patients prescribed long-acting/extended release opioids who were opioid-naive | 8.70% | 5.20% | 4.8% (2022 Q3) |
| Treatment and Recovery | |||
| Number of Buprenorphine waivered prescribers practicing in Kansas | 97 | 150 | 218 |
| Rate of Kansas prescribers who prescribed buprenorphine indicated for Medication-assisted Treat (MAT) per 100,000 residents | 7.1 | 9.1 | 22.4 (2022) |
| Law Enforcement | |||
| Percentage of law enforcement agencies responding to the naloxone survey that indicated they allowed carry and use of naloxone | ̶ | 50.00% | 65.30% |
Table 2. Previous Strategic Plan Indicators Made Progress in Intended Direction6
| State-level Indicator | Baseline | Target | 2021 Value |
| Morbidity | |||
| Age-adjusted All Drug Non-Fatal Overdose Hospitalization Rate per 100,000 population | 116.8 | 105.1 | 112.5 |
| Age-adjusted Non-Fatal Opioid Overdose (excluding heroin) | 23.8 | 21.4 | 18.9 |
| Hospitalization associated with opioid abuse or dependence (age-adjusted rate per 100,000 population) | 83 | 74.7 | 71.5 |
| Prevention | |||
| Percentage of youth in Kansas in grades 6th, 8th, 10th,and 12th reporting use of prescription medications not prescribed to them in the past 30 days | 3.70% | 1.20% | 1.60% |
| Percentage of youth in Kansas in grades 6th, 8th, 10th,and 12th who report there is “no risk” | 10.00% | 6.80% | 7.40% |
| Neonatal Opioid Withdrawal Syndrome (NOWS) (Formerly NAS) | |||
| Incidence rate of NOWS in Kansas, per 1,000 birth hospitalizations | 3.4 | 2.6 | 2.9 (2020) |
| Provider Education | |||
| Total morphine milligram equivalents (MME) dispensed to patients per capita | 196.8 | 75 | 104.2 (2022 Q3) |
| Rate of patients with 5+ prescribers and 5+ dispensers in a 6-month period | 15.40% | 0.4 | 1.5 (2022 Q3) |
| Percent of patients with 90+ daily MME of opioids | 11.10% | 2.20% | 6.0% (2022 Q3) |
| Treatment and Recovery | |||
| Percentage of Kansas counties with perscribers who prescribed buprenorphine indicated for medication assisted treatment (MAT) | 27.00% | 100.00% | 35.00% |
Kansas Prescription Drug Monitoring Program
K-TRACS, the state prescription drug monitoring program (PDMP) authorized by law in 2008 (KSA 65-1683), has been operating since April 1, 2011. The program provides a database of controlled substance prescriptions that have been dispensed by Kansas pharmacies and from out-of-state pharmacies to Kansas residents. The purpose of the database is to provide up-to-date web-based patient information to assist prescribers in providing appropriate treatment to patients. Additionally, drugs classified as schedule II through IV are monitored.
The program requires pharmacists to document prescription-dispensing data on every written controlled substance prescription. It also allows both prescribers and pharmacists to check prescription histories to determine, in advance, if patients are acquiring drugs from multiple prescribers or pharmacies.
Drug Treatment Courts in Kansas
In 2022, the Kansas Legislature passed Senate Sub. for HB 2361, which required the Kansas Supreme Court to adopt rules for establishment and operation of specialty court programs within the state, including drug courts for people with substance use disorder. Drug treatment courts are established as an alternative to incarceration for those convicted of misdemeanors. They offer treatment, support, and counseling. With oversight from the court, a person with substance use disorder can complete a drug treatment program and work on lifestyle changes, often in lieu of going to jail.
As of 2023, while there is not a statewide program, the cities of Kansas City, Topeka, and Wichita have developed their own municipal- or county-level programs, and 11 of the 31 judicial districts have drug treatment courts, which includes Allen, Chase, Cowley, Douglas, Ellis, Geary, Johnson, Lyon, Reno, Riley, Sedgwick, Shawnee, and Wyandotte counties.
Strategies Used by Other States
Prescription Drug Monitoring Programs
With the launch of Missouri’s PDMP in 2023, all 50 states have PDMPs in place to track the prescribing and dispensing of all controlled substances. State requirements vary concerning who and what is tracked, who is required or authorized to check or submit information, and the frequency information needs to be checked and updated. Many states share their data with other states’ PDMPs and authorized users in those states. However, there are no federal regulations requiring states to share their information with other states or the federal government.
Limiting Prescriptions
As of 2022, 32 states have enacted a limit on initial opioid prescriptions, ranging from a three-day supply (Florida, Kentucky, Tennessee, and 7West Virginia) to a 14-day supply (Nevada, specifically for prescriptions meant to treat acute pain). A seven-day initial supply is the most common limit, with 24 states implementing a seven-day limit on all or specific types of opioid prescriptions, such as those intended for minors. Several states impose different limits depending on the prescriber or reason for treatment. For example, Pennsylvania limits prescriptions originating in emergency rooms and urgent care or those written for minors to a seven-day initial supply.
Opioid Intervention Court
Buffalo, New York, created the nation’s first opioid crisis intervention court in 2017 after determining its ordinary drug treatment court was not enough to combat the opioid crisis. The court admits people into treatment in a matter of hours instead of days, requires them to check in with a judge every day for one month, and utilizes strict curfews. It has been funded via a U.S. Justice Department grant with the intent of treating 200 people in a year. During the first nine months of the program, only one of the 92 people in the program had overdosed. Since its establishment, the state of New York has expanded the model and established a total of 35 new opioid courts through its Unified Court System, and similar specialty courts have been created in Arizona, Pennsylvania, and Wisconsin.
Good Samaritan Overdose Immunity Laws
As of May 2023, the Network for Public Health Law8 reports that 48 states and the District of Columbia have enacted at least one overdose Good Samaritan law. These laws provide immunity from arrest, charge, or prosecution for certain controlled substance possession and paraphernalia offenses when someone is either experiencing an opioid-related overdose or calling 911 to seek medical attention for someone else experiencing an opioid-related overdose. What is covered under the law varies depending on the state. Kansas’ good Samaritan law (KSA 65-2891) is limited specifically to health care providers rendering emergency services at the scene of an accident or emergency. Kansas and Wyoming are the only two states that do not have a Good Samaritan Law specific to drug overdoses.
Naloxone Access
All 50 states have passed legislation to expand access to naloxone in some form. Naloxone, also known by the brand name Narcan, is an opioid antagonist that can bind to opioid receptors and reverse or block the effects of other opioids, thereby reversing opioid-induced overdoses. It can be administered via nasal spray or injected into the outer thigh muscle, veins, or under the skin. New evidence has shown that opioid-related deaths have been reduced by 9.0 to 11.0 percent in states that have promoted naloxone. Some states, such as Arizona, Maryland, and New Mexico, have utilized Medicaid to purchase naloxone to promote access for the public. Some states are also providing naloxone to at-risk inmates, as well as training on how to use it upon their release from jail. Officials hope this will reduce overdose deaths and expand the community’s knowledge about naloxone and how to use it.
Needle Exchanges
Forty-three states and the District of Columbia have some form of a needle exchange program. Currently, only 1 in 4 drug users obtains needles from a sterile source. With the increase in the use of heroin and other drugs injected via needle, there is also a rise in the number of cases of HIV and hepatitis B and C. One way to help combat the spread of disease is to facilitate access to sterile needles via needle exchanges. The federal government lifted a ban on federal funding for needle exchanges in early 2016. Some states have also followed suit by making it easier to establish needle exchanges, as well as helping people enter a program who want to find treatment.
- https://www.cdc.gov/opiods/basics/terms.html ↩︎
- dea.gov/factsheets/fentanyl ↩︎
- cdc.gov/stopoverdose/fentanyl/index.html ↩︎
- kslegislature.org/li/b2023_24/committees/ctte_h_corr_juv_jus_1/documents/testimony/20230215_23.pdf ↩︎
- https://www.kdhe.ks.gov/DocumentCenter/View/12040/2022—2027-Kansas-Overodse-Prevention-Strategic-Plan-PDF ↩︎
- https://www.kdhe.ks.gov/DocumentCenter/View/12040/2022—2027-Kansas-Overodse-Prevention-Strategic-Plan-PDF ↩︎
- West Virginia’s law limits initial opioid prescriptions written by dentists or optometrists to three days. ↩︎
- https://www.networkforphl.org/wp-content/uploads/2023/07/Legal-Interventions-to-Reduce-Overdose-Mortality-Overdose-Good-Samaritan-Laws-2.pdf ↩︎
by Amanda Prosser
Fiscal Analyst
785-296-7879
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