On March 24, Nebraska state Sen. Sara Howard and her mother, former Sen. Gwen Howard, will celebrate Carrie Howard Day, marking the ninth anniversary of the death of Sara's sister and Gwen's daughter with slushies, junk food and John Hughes movies.
While the tradition is a personal and momentous way to remember the 33-year-old who died in 2009 from an opioid overdose, there are far more weighty things the two women have done to honor her and others who have fallen victim to opioid addiction.
At the time of Carrie's addiction, said Sara Howard, people didn't realize the dangers of the drugs. Now, opioids are part of a national conversation in a way they never were, she said.
"There was so much heartbreak and so much shame around addiction as a whole. And with Carrie, we didn't understand what was going on. We put a lot of faith in the people who were prescribing to her, not realizing there were so many," she said.
Gwen Howard initially, and now Sara Howard, as senators in the Nebraska Legislature, have brought attention to the opioid crisis in Nebraska. They worked to establish the Nebraska Prescription Drug Monitoring Program, which collects dispensed prescription information and makes it available to health care professionals.
The bill creating the program was passed in 2011 and updated in 2016.
"We're cutting-edge in Nebraska in that we collect all prescriptions that are dispensed, not just opioids," Sara Howard said.
This year, she's worked with two other senators — John Kuehn of Heartwell and Brett Lindstrom of Omaha — to go beyond the monitoring program and introduce four bills that address the addiction and overdose problems that are increasing in Nebraska.
In 2016, 116 people died every day nationwide from opioid overdoses, and 11.5 million misused the prescription drug. It's harder to track the number of deaths in Nebraska because opioid overdoses are not specifically listed on death certificates. In 2015, 149 Nebraskans died of a drug overdose, and it's believed that at least 54 were opioid-related.
Bills introduced this session would notify patients and parents of young patients of the addictive nature of the drugs, provide a cap of seven days on prescriptions of the drugs for minors, require identification from people picking up the drugs and allow for inmates leaving prison to have access to an injection that could assist in reducing or eliminating the inmate’s use of opioids for 30 days, until they could get substance-abuse treatment.
Howard said when a person is addicted to opioids, their brain chemistry shifts into thinking the drug is needed to function, and they crave them as they would other needs such as food or sleep. That kind of addiction is hard to overcome, she said.
Now that the prescription drug-monitoring program is in place, the Legislature can turn its attention to what more the state can do, Howard said.
Kuehn's bill (LB934) would require the person picking up an opioid prescription to show a photo ID — a state or military ID, alien registration card or passport. It would provide a pause, Kuehn said, for anyone attempting to divert an opioid prescription. It also would give the prescriber a way to ensure the drug gets into the proper hands.
Lindstrom's bill (LB933) provides education for people who are prescribed an opioid.
"I think most people know an opioid's a pretty powerful substance, but we're just making sure we're covering all of our bases," he said.
It requires a prescriber of an opioid or controlled substance to explain the risks of addiction and overdose associated with the drug, that it is highly addictive even when taken as prescribed, the risk of developing a physical or psychological dependence, the dangers of taking more than prescribed and that mixing sedatives, benzodiazepines, or alcohol with drugs can result in fatal respiratory depression.
Howard's bill (LB931) puts a cap on the amount of an opioid a prescriber can give a patient younger than 19. If the practitioner hasn't previously prescribed an opioid for the patient, he or she must discuss the risks associated with the drug with a parent or guardian and the reasons why the prescription is needed. If more of the drug is needed for chronic pain management, the practitioner can prescribe the amount needed, but indicate that in the patient's medical record and explain why an alternative drug was not appropriate.
In October, the Nebraska Department of Health and Human Services announced new prescribing guidelines for drugs commonly used to treat acute and chronic pain.
Law enforcement agencies in the state have opened investigations into prescribing practices based on data entered in the state's prescription drug-monitoring program.
Naloxone — an antidote that reverses opioid effects during an overdose — has become more readily available for law enforcement officers to administer.