White House Opioid Commission Publishes Interim Report, Recommendations
On Monday, July 31, the White House Commission on Combating Drug Addiction and the Opioid Crisis published its interim report. It included nine recommendations President Trump can take to combat the nation’s opioid crisis, to prevent deaths and provide more accessible and informed methods of treatment for opioid addiction. With 142 Americans dying every day from an opioid overdose, the Commission called on the President to declare a state of national emergency.
The President’s Commission first met in mid-June of this year and spent much of its time meeting with behavioral health experts nationwide, including National Council Medical Director Dr. Joe Parks. Dr. Parks highlighted the importance of treating mental illness along with opioid addictions, as they often are co-occurring.
Highlights of the interim report include:
Eliminating Institutes of Mental Disease (IMD) Exclusion
The IMD exclusion prohibits Medicaid from paying for residential treatment for mental health and substance use disorders (SUDs) in facilities of 16 beds or more. As a result of the policy, capacity for residential addiction treatment has been limited. The Commission encourages the federal government to increase treatment capacity by granting waiver approvals for all 50 states to eliminate barriers to treatment resulting from the IMD exclusion within Medicaid.
Strengthening Enforcement of Mental Health and Addiction Parity
The report urges President Trump to aggressively enforce and apply penalties to violations of Mental Health Parity and Addiction Equity Act (MHPAEA), which states that mental health and addiction services must be covered by health insurance to same extent as physical health services. Specifically, the Commission recommends establishing a compliance tool to ensure that health plans cannot impose less favorable benefits for mental health and substance use diagnoses versus physical health diagnoses, consistent with the 2008 parity law.
Strengthening, Simplifying Prescription Drug Monitoring Programs (PDMPs)
PDMPs are state-run electronic databases that track prescribing and dispensing of medications. These databases provide prescribers information about a patient’s history with prescription medications. They are meant to help identify patients at risk for abuse of opioids and other drugs and aim to assist providers in safely prescribing and dispensing medications. Despite their growing popularity, PDMPs remain greatly underutilized in practice. The Commission recommends:
- Federally mandating all clinicians check their state’s PDMP before prescribing opioids (31 states already require this);
- Supporting interstate PDMP data sharing through additional federal funding and technical support to states;
- Simplifying PDMP use, and including other data to assist providers; and
- Achieving data sharing among all state and federal PDMP systems, led by the Departments of Veterans Affairs and Health and Human Services (HHS) by July 1, 2018.
Increasing Access to Medication-Assisted Treatment (MAT)
MAT is used as a combination of medication and behavior therapies to provide treatment to those with substance use disorders. Some recommendations from the Commission include:
- Establishing and funding a federal incentive to increase access to medication assisted treatment;
- Partnering with the National Institutes of Health and pharmaceutical companies to develop new MAT options and non-opioid pain relievers;
- Increasing access of MAT by requiring all physicians, physician assistants, and nurse practitioners at Federally Qualified Health Centers (FQHCs) to possess waivers to prescribe buprenorphine;
- Requiring the Department of Justice to coordinate with HHS and the White House Office of National Drug Control Policy to increase access and use of MAT with criminal justice-involved populations.
Enhancing Prescriber Education
The Commission noted that the most important prevention tools the health system has are providers, and that they should be better utilized in this time of crisis. Specifically, the Commission recommends that medical and dental schools mandate education on opioid prescribing and risks of developing a substance use disorder.
As the report stated, “This crisis began in our nation’s health care system. While we acknowledge that some of this inappropriate overprescribing is done illegally and for profit, we believe the overwhelming percentage is due to a lack of education on these issues in our nation’s medical and dental schools.” Through providing mandated courses in proper treatment of pain for all Drug Enforcement Administration registrants, and continuing education, providers can help prevent many cases of opioid use disorder from the start.
The Commission highlighted education programs in Massachusetts and New Jersey and called for a national implementation of their practices. Some of these best practices include: requiring continued opioid education for prescribers, showing competency in safe prescribing and pain management, and mandated discussions of the risks of opioid use with patients.
Other important recommendations include:
- Providing legislation to allow naloxone dispensing through standing orders (to be distributed by a health care professional when certain conditions are met, such as an overdose); and
- Equipping all law enforcement officials with naloxone.