Opioid Addiction is the Cancer of Our Generation

The final commission recommendations

The final commission recommendations were released with 56 specific items. So what has already been addressed and what has not based on the preliminary recommendations? The following occurred prior to the final recommendations:

  • Increased access to treatment at centers with more than 16 beds by allowing a Center for Medicare and Medicaid Services (CMS) waiver (each state Governor must apply)
  • All federally employed prescribers have been directed to receive special training to provide medication-assisted treatment
  • Measures have been implemented to decrease the flow of illicit drugs into the country via the postal service
  • NIH has partnered with pharmaceutical companies to develop non-addictive painkillers and new treatments for addiction and overdose
  • More data sharing among state prescription drug monitoring programs and relaxing patient privacy regulations to allow improved ability to treat patients with substance use disorder (SUD)
  • Full enforcement of Mental Health Parity and Addiction Equity Act to increase benefits for mental health and substance use diagnoses

Related articles: Here is a link to Dr. Dye’s two previous commentaries on the preliminary recommendations from Trump’s opioid commission.

Federal funding and programs

To improve the delivery of federal funding to states, the commission urged Congress and the administration to block grant federal funding for opioid- and SUD- related activities to the states. Block granting allows a large sum of money from the federal government to be spent with limited provisions on how. Evidence-based programs would be funded through these grants. The commission also acknowledges the need for better data analysis and accountability to ensure that the dollars are spent on the most effective solutions. One of the big problems with government spending is that so much money goes into the bureaucracy and not enough makes it to the heart of the problem. Maybe, in this case, it will be different.

Opioid addiction prevention

Many don’t know that prescribing opioids is often the cheapest way to “address” acute and chronic pain. The commission identified a disturbing trend in federal healthcare reimbursement policies that incentivize the prescribing of opioids and limit access to non-addictive treatments for pain.

Opioid addiction treatment, overdose reversal, and recovery

HHS/CMS, the Indian Health Service, Tricare, and the VA still have reimbursement barriers to substance abuse treatment, including limiting access to certain FDA-approved medication-assisted treatment, counseling, and inpatient/residential treatment. It’s imperative that federal treatment providers lead the way by treating addiction as a disease and removing these barriers. Primary care providers employed by these federal health systems should screen for SUDs and, directly or through referral, provide treatment within 24–48 hours. Each physician employee should be able to prescribe buprenorphine (if that is the most appropriate treatment for the patient) in primary care settings. For individuals with a SUD, ensuring life-saving access to affordable healthcare benefits is an essential tool in fighting the opioid epidemic.

Drug courts

The commission also recommends that drug courts be established in all 93 federal district courts and that they embrace the use of medication-assisted treatment. Drug court offers the option of treatment and probation rather than incarceration. Eligibility requires very strict criteria be met before this option is offered. Not only does this increase the chances that many will receive appropriate treatment, it may decrease the prison population. There is data to support that drug courts are more effective than incarceration, yet 44% of U.S. counties do not offer it. Medication-assisted treatment can lead to lasting recovery when abstinence-only may not.

The bottom line

The commission’s final report is very extensive and has many recommendations. It is not surprising that the major themes are prevention and increasing access to treatment. Education is such a huge part of the solution and is addressed in the report. Those with opioid use disorder continue to use because they don’t believe they have a choice. For someone without the disease, it is very difficult to conceive.

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The Doctor Weighs In

The Doctor Weighs In

Dr. Patricia Salber and friends weigh in on leading news in health and healthcare