Drug policy is personal for a legislator in Nebraska by Courtney Daniel
Carrie Howard died March 24, 2009. Carrie, the daughter of former Nebraska state Sen. Gwen Howard and sister of Sen. Sara Howard, is one of many lives lost to the opioid epidemic. While her story begins like many others—a severe car accident and a prescription for painkillers— her story ends a little differently. Carrie’s life, and untimely death, galvanized the Nebraska Legislature to tackle the opioid epidemic head on through a series of legislation spearheaded by her mother and sister.
MAR/APR 2018 | CAPITOL IDEAS
Carrie’s mother, Gwen, served in the Legislature eight years before her sister, Sara, ran and won the seat her mother was vacating in 2012. While Gwen was serving, Sara was attending law school with little intention of returning to Omaha. During that time, Carrie had a series of car accidents that changed the course of her life, her family’s life and the future of opioid policy in Nebraska.
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“I didn’t know and I didn’t understand what addiction was at the time, but she clearly needed the drugs to function and eventually she needed them not because of the pain, but because there was a lot of pain associated with when she didn’t have them,” Sara said. “After that, it became years’ worth of struggle where she would get better and not be taking any medications, and then, for instance, she’d go to a dentist and they would do oral surgery and give a prescription for OxyContin or Vicodin and she would relapse back.”
Doctors were prescribing the medicines without knowing what her history or other prescriptions were because there wasn’t a mechanism in place for doctors or pharmacists to access the information. “What we didn’t know was that as addicts progress, and as my sister progressed, she got really good at doctor shopping,” Sara said. “She would have one doctor associated with one pharmacy and none of them were talking to each other and she could get a lot of pills that way.” In 2011, the former Nebraska senator, Gwen Howard, worked to pass legislation to solve this problem. She passed LB 237 that created the Nebraska Prescription Drug Monitoring Program, or PDMP. The PDMP, a statewide tool that collects prescription information, is housed in the Nebraska Health Information Exchange. Medical professionals can use this tool to access a comprehensive medical history electronically.
“Before she was really comfortable talking about Carrie’s illness and before anybody understood what was going on with opioids in our country, my mom created our first prescription drug monitoring program,” Sara said. “Innovation wise, Nebraska is cutting edge when it comes to electronic health records and information sharing.” In 2015, Sara filed LB 471, a full reboot of the PDMP. It required every patient to be included in the PDMP, medical providers no longer had to pay to use the system, every provider had to participate and pharmacies were added to the program. “This bill made the system free for all prescribers and dispensers, so doctors and pharmacists can see what is being dispensed,” Sara said. “We also worked with the veterinarians because in Nebraska they can dispense narcotics over the counter. I would venture a guess that we have the most comprehensive prescription drug monitoring system in the country.” Nebraska, which has the nation’s only unicameral and nonpartisan legislative body, passed the bill in February 2016 with no opposition. This year, Sara and her colleagues Sen. Brett Lindstrom and Sen. John Kuehn are leading the Nebraska Legislature to pass additional opioid legislation. Lindstrom has filed a bill that would require doctors and other prescribers to share information about opioid addiction with patients before prescribing them. Kuehn’s legislation would require a valid ID to pick up opioid pre-