President's opiate commission issues recommendations

Nov 03 2017

President’s opiate commission issues recommendations

President Trump’s commission on combating the opioid epidemic  has called on the federal government to establish drug courts in every federal judicial district, lower barriers to treatment, tighten prescribing standards and adopt a block grant system to fund state and local addiction treatment and prevention programs.

Those are among the 56 measures proposed by the commission in its report released on Wednesday. Among the recommendations:

— The Department of Justice should establish drug courts in each federal judicial district, so that defendants with substance use disorder can be diverted to a drug court, rather than prison. According to the commission, less than one-third of federal judicial districts and 44 percent of U.S. counties have drug courts, which have been proven to increase participation in addiction treatment and lower recidivism rates.

— To expedite distribution of opiate-related funding to states and cities, the federal government should adopt a block grant system, similar to the one used by the Substance Abuse and Mental Health Services Administration.

— The Centers for Medicare and Medicaid Services should review policies that incentivize the prescription of opioids over more expensive, non-opioid treatments. Also, the Department of Health and Human Services should review its rate-setting policies to more accurately measure and cover the “true costs” of treating substance use disorder, including the use of inpatient psychiatric facilities.

— The federal government should take steps to provide more access to FDA-approved medication assisted treatment, and access to recovery coaches.

–The federal Office of Emergency Medical Services should recommend that local communities revise their guidelines, if necessary, to allow emergency medical technicians to administer the overdose-reversing drug naloxone. Paramedics and advanced medical technicians are currently authorized to administer the life-saving medication, but some states prohibit some types of emergency responders from using naloxone.

— The Drug Enforcement Administration should require prescribers of opiates to participate in an educational course in safe prescribing practices. The commission also recommends that that the Department of Health and Human Serves develop a “national curriculum and standard of care for opioid prescribers,” and that pharmacists receive training “on best practices to evaluate the legitimacy of opioid prescriptions.”

The report also recommends taking steps to ensure patients are adequately educated about the “risks, benefits, and alternatives of taking opioids” before receiving an opioid prescription for chronic pain.

— The White House should encourage passage of the Prescription Drug Monitoring Act, legislation now before Congress that would require states receiving federal grant money to maintain prescription drug monitoring programs and share data with a national center to be established by the Department of Justice.

The commission also recommended that the DEA and Office of National Drug Control Policy combine PDMP data with electronic health records systems, and that the DEA and the Office of National Drug Control Policy expand electronic prescribing to prescription fraud and misuse.

In a statement, the National Association of Addiction Treatment Providers (NAATP) called for the government to give top priority to fully implementing the Mental Health Parity and Addiction Equity Act (Parity).

“Not only is enforcement on the list, the Commission recommends that monetary penalties be assessed on insurers who fail to comply,” said Mark Dunn, NAATP director of public policy. “A uniform tool to monitor compliance and transparency regarding reasons for denials would also be a very positive development.

“Many of the recommendations fall to the Office of National Drug Control Policy (ONDCP) to enforce,” Dunn said. “NAATP urges the Administration to appoint a Director with broad experience and knowledge of recovery.

“While the Commission did not identify additional dollars to fund its recommendations, that responsibility now falls to Congress and the Administration.”