November 2, 2017

The 56 recommendations from the White House opioid crisis commission

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    The White House Commission on Combating Drug Addiction and the Opioid Crisis on Wednesday released a report detailing 56 recommendations for the federal government to combat the U.S. opioid misuse epidemic.

    Your top resources for combatting the opioid epidemic in one place

    The commission was established in March under an executive order and is tasked with studying the opioid misuse epidemic and developing strategies to combat opioid and substance misuse.

    Recommendations

    Generally, the commission recommended that the federal government should:

    • Bolster first-responders' access to naloxone, a drug that can reverse the effects of an opioid overdose;
    • Develop toxicology and forensic procedures to use while investigating drug-related deaths as a way to bolster data on drug-related overdose deaths that occur in the United States;
    • Expand access to and increase funding for treatment for substance use disorders; and
    • Increase access to medication-assisted treatment for opioid-related substance use disorders, as well as access to recovery coaches.

    Recommendations on provider reimbursements, prescribing

    As part of efforts to increase access to treatment, the commission said HHS should review the rates it pays substance use disorder treatment providers to ensure such rates cover the "true costs" of treatment, including services provided in inpatient psychiatric facilities. The commission also said the federal and state regulators should better ensure parity between access to and coverage for mental health and substance use disorder services and those for physical health.

    The commission suggested that the Drug Enforcement Administration require prescribers seeking new licenses to complete an opioid prescribing education program, and that HHS create a "national curriculum and standard of care for opioid prescribers." The commission also said pharmacists should be trained "on best practices to evaluate the legitimacy of opioid prescriptions."

    In addition, the commission said CMS should review policies that might encourage providers to prescribe opioids over non-opioid medications. For instance, the commission said the federal government should eliminate questions regarding patients' pain levels on CMS' patient satisfaction surveys to ensure providers are not incentivized to prescribe opioids as a way to increase patient approval.

    Recommendations for state, federal agencies

    Further, the commission said FDA during its approval process for opioid drugs should require long-term trials that study the number of doses and duration for which the drugs should be prescribed for specific indications, as well as the likelihood that the drugs could be misused or diverted.

    The commission suggested establishing drug courts in all federal judicial districts that help direct individuals with opioid-related substance use disorders away from the prison system and toward treatment. According to the report, less than one-third of federal judicial districts in the United States had drug courts as of 2015. In addition, the commission suggested enhancing legal consequences for individuals convicted of trafficking fentanyl.

    The commission also said the federal government should streamline the way it distributes funding to combat opioid misuse to states, citing the Substance Abuse and Mental Health Services Administration's process for doling out state block grants as a successful example. The commission recommended that the White House's Office of National Drug Control Policy (ONDCP) monitor how states are using the federal funding. The report stated, "If we are to invest in combating this epidemic, we must invest in only those programs that work," adding, "We are operating blindly today; ONDCP must establish a system of accountability."

    Further, the commission said the White House should coordinate with private-sector and nonprofit groups and fund a "wide-reaching, national multi-platform media campaign addressing addiction stigma and the danger of opioids," as well as implement policies to make sure individuals are properly educated about the "risks, benefits, and alternatives of taking opioids" before they are prescribed an opioid drug to treat chronic pain. In addition, the commission said the Department of Education should work with states to implement programs intended to identify individuals in middle school, high school, and college who are at risk of substance use disorders and need treatment.

    The commission said the White House also should endorse legislation currently before Congress, called the Prescription Drug Monitoring Act (S 778), which would require states that receive federal grant money to meet certain regulations for prescription drug monitoring programs and to share their data with a national monitoring system that would be created by the Department of Justice. The commission also recommended that data collected from such programs be integrated with EHR systems.

    A need for funding

    The commission in the report did not suggest how to fund the initiatives it suggested or note how much the initiatives would cost. The panel wrote, "It is not the commission's charge to quantify the amount of these resources, so we do not do so in this report."

    However, the commission did note that funding would be the major impediment to implementing its recommendations. The commission in the report called on "Congress to respond to the President's declaration of a public health emergency" over the opioid misuse epidemic "and fulfill their constitutionally delegated duty and appropriate sufficient funds to implement the commission's recommendations," but stopped short of calling for new funding to combat the epidemic.

    Some stakeholders have said the federal government will struggle to implement many of the commission's recommendations without new funding, Politico reports.

    Chuck Ingoglia, vice president of public policy at the National Council for Behavioral Health, said, "It's great to have good ideas but you need money to implement them."

    Andrew Kessler—founder of Slingshot Solutions, a consulting firm that specializes in behavioral health—said, Congress should consider the recommendations and allocate appropriate funding for them (Bernstein, "To Your Health," Washington Post, 11/1; Roubein, The Hill, 11/1; Lopez, Vox, 11/2; Ross Johnson, Modern Healthcare, 11/1; Zimmerman, Becker's Hospital Review, 11/1; Facher, STAT News, 10/30; Diamond, "Pulse," Politico, 11/1; Ehley/Karlin-Smith, Politico, 10/31).

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