Opioid Commission Interim Report – Calls for Mandatory CME for Opioid Prescribers

The White House’s Commission on Combating Drug Addiction and the Opioid Crisis (Opioid Commission) has issued an interim report, which offers recommended actions for President Trump to take now, with more recommendations planned for the fall of 2017. The headline-creator of the report was the recommendation to President Trump that he declare the opioid epidemic a national public health emergency and expedite funds and resources to stop the crisis.

The Opioid Commission discussed its outreach to individuals and organizations, including all fifty Governors and bipartisan members of Congress, providers, insurers and medical and treatment societies.  It has received more than 8,000 comments from the public, including comments from at least fifty organizations.

Overprescribing of opioid pain relievers has been widely viewed as the leading cause for the rise in opioid-related substance abuse cases and overdose deaths over the past decade. Opioids accounted for more than 63% of the more than 52,000 drug overdose deaths that occurred in the U.S. in 2015, according to the Centers for Disease Control and Prevention. Among opioid-related deaths, more than 15,000 involved the use of a prescription opioid.

The commission advised Trump to enforce current federal law and to ensure that health plans do not impose less favorable benefits for particular diagnoses, including those surrounding mental health and substance abuse.

“This is simply an issue of equity and medical civil rights so that patients who have an illness not unlike any other chronic illness are not treated differently by their insurers,” said former Rep. Patrick Kennedy, a member of the commission. “I believe a lot of the denial we are seeing in insurance coverage stems from the overall denial that our country is living in when it comes to this healthcare crisis.”

Recommendations of the Opioid Commission include:

• Rapidly increase treatment capacity and grant waiver approvals for all 50 states to quickly eliminate barriers to treatment resulting from the federal Institutes for Mental Diseases (IMD) exclusion within the Medicaid program;
• Mandate prescriber education initiatives by working with medical and dental schools across the country;
• Mandate medical education training in opioid prescribing and risks of developing an SUD by amending the Controlled Substance Act to require all Drug Enforcement Administration (DEA) registrants to take a course in proper treatment of pain;
• Establish and fund a federal incentive to enhance access to Medication Assisted Treatment (MAT). Require that all modes of MAT are offered at every licensed MAT facility and that those decisions are based on what is best for the patient. Partner with the National Institutes of Health (NIH) and the industry to facilitate testing and development of new MAT treatments;
• Provide model legislation for states to allow naloxone dispensing via standing orders, and require the prescribing of naloxone with high-risk opioid prescriptions;
• Equip all law enforcement in the United States with naloxone to save lives;
• Prioritize funding and manpower to the Department of Homeland Security’s Customs and Border Protection, the DOJ Federal Bureau of Investigation, and the DEA to quickly develop fentanyl detection sensors and disseminate them to federal, state, local, and tribal law enforcement agencies;
• Support federal legislation to staunch the flow of deadly synthetic opioids through the U.S. Postal Service;
• Provide federal funding and technical support to states to enhance interstate data sharing among state-based prescription drug monitoring programs (PDMPs) to better track patient-specific prescription data and support regional law enforcement in cases of controlled substance diversion;
• Regulate and better align patient privacy laws to ensure that information about SUDs be made available to medical professionals treating and prescribing medication to a patient; and
• Enforce the Mental Health Parity and Addiction Equity Act (MHPAEA) with a standardized parity compliance tool to ensure health plans cannot impose less favorable benefits for mental health and substance use diagnoses verses physical health diagnoses.

The Opioid Commission notes that in its final report in the fall, it will “provide an additional set of detailed recommendations that, if implemented, will ensure that the Federal Government operates as a strong partner in the fight against addiction and the opioid crisis.”