Fighting the nation’s deadly opioid epidemic will, hopefully, get a little easier for hospitals, after some big announcements from the White House today.
President Obama unveiled an array of efforts today, aiming to curb the spread of prescription painkillers and street heroin that is killing thousands of Americans each year. Those include expanding access to treatment for opioid addicts, bolstering drug use prevention strategies at the local level, and rolling out tools to prevent further overdose deaths. As we reported in our March cover story, America saw nearly 30,000 individuals die from opioids in 2014, the year with the most recently available data from the CDC, a quadrupling of that number since 2000.
“When you look at the staggering statistics — in terms of lives lost, productivity impacted, costs to communities, but most importantly costs to families from this epidemic of opioid abuse — it has to be something that is right up there at the top of our radar screen,” Obama said during a panel discussion at the National Prescription Drug Abuse Summit this afternoon in Atlanta.
Addressing the opioid epidemic has been pegged as a top priority for President Obama in his final year, and today’s announcement builds upon his proposal to put nearly $1.1 billion toward curbing opioid use. However, the president emphasized that those dollars have yet to be slated to by Congress, and today’s commitments of new funding come from the reallocation of existing money.
Some of that reshuffling of federal dollars includes about $94 million from Health and Human Services for 271 community health centers across the country, aiming to increase the prevalence of medication-assisted treatments for those addicted to opioids. The White House’s announcement estimates that those dollars will help to treat about 124,000 new patients with substance use disorders.
President Obama was joined on the panel by a recovering addict from Ohio named Crystal Oertle, who was able to kick her habit with the help of Suboxone, blocking her cravings. Today’s announcement hopes to help others such as Crystal, by expanding from 100 to 200 the number of patients to whom docs can prescribe buprenorphine medications like Suboxone.
Another panelist, Baltimore Health Commissioner Leana Wen, M.D., told a heartbreaking story of a swimmer who received opioids following an injury. She frequently showed up at area emergency departments, but there was nothing doctors could do. She had an appointment scheduled for treatment in just a few short weeks, but died of an overdose before she could make it.
Wen said the system desperately needs to expand access to treatment and begin to address addiction as a disease, and the president agreed.
“We have to recognize in this global economy of ours that the most important thing we can do is to reduce demand for drugs, and the only way that we reduce demand is if we’re providing treatment and thinking about this as a public health problem, and not just a criminal problem,” Obama said.
Another key piece of today’s announcement is a new task force launched by the president to ensure that insurers are covering mental health and substance use disorder benefits in the same fashion as medical and surgical benefits. HHS is also finalizing a rule so that the same can be said for Medicaid and Children’s Health Insurance Program plans. “We’ve got to let the insurance carriers know that we’re serious about this,” Obama said.
The president also put the onus on hospitals and health systems to move toward a more wellness-based approach to the crisis, treating opioid addicts before they end up in the ED.
“We have a health care system that too often is a disease care system,” Obama said. “We wait until people get sick and then we treat them, and we don’t spend enough time thinking about how we keep people well and healthy and balanced and centered in the first place. That requires a reimagining of how our health system works. Very specifically with respect to opioids, the training of doctors for pain and pain relief, and how they help their patients manage pain; this is an area where I was shocked to learn how little time residents in medical schools were spending trying to figure this out.”
As such, more than 60 medical schools also announced today that, beginning in the fall semester, they’ll require students to take courses on safe prescribing, in line with the CDC’s new guidelines. Those include the Ohio State University College of Medicine, located in a state that’s been ravaged by the opioid epidemic. The school is now putting together an e-learning program for students and residents specifically tied to those guidelines, set to be released this summer. “Opioid addiction is a substantial problem for the citizens of Ohio and we feel through effective education programs we can ensure that clinicians will be best equipped to manage pain, monitor for opioid abuse and provide effective interventions,” Dan Clinchot, M.D, vice dean for education at OSU's College of Medicine, told me in an email.
The new rules are welcomed by some by the field, including R. Corey Waller, M.D., an addiction, pain and emergency medicine specialist who was in attendance at the panel today. Navigating the complicated maze of what is and is not covered by insurers is difficult, he says. Often, when colleagues from around the country call him for advice on opioid treatment, he has to ask what ZIP code they’re calling from because of the vast differentiation. “It is a spider web of pathways to try to figure out how stuff is paid for and if it’s even paid for,” he said.
Expanding the number of patients to whom docs can dispense buprenorphine is helpful, but Waller wishes it went further to include more types of docs and a larger swath of patients. He says today’s initiatives are a solid start, but more legislative reform is needed to truly put an end to the opioid epidemic.
“The biggest thing is [that] this is Step 1 and without further legislation, I think we would be at risk for not solidifying this path forward,” he said.
Here’s a quick look at 10 actions the administration is taking, as announced by the president this afternoon:
- Health & Human Services is issuing a new proposed rule that increases the number of patients to whom physicians can prescribe buprenorphine. That threshold will leap from 100 to 200 patients to whom each doc can prescribe the evidence-based opioid treatment.
- HHS is also releasing $94 million in new funding to 271 community health centers across the U.S., aiming to increase substance use treatment services. The major focus is on expanding medication-assisted treatment, the administration says, with those dollars expected to help treat some 124,000 new patients with substance use disorders.
- The Substance Abuse and Mental Health Services Administration is also releasing some $11 million in funding for up to 11 states to expand treatment services using medications like buprenorphine and methadone. Plus, SAMHSA is distributing 10,000 pocket guides to clinicians who prescribe meds to treat opioid addiction.
- President Obama today also directed the creation of a new task force charged with advancing access to mental health and substance abuse treatment, along with promoting best practices and developing further guidance. Such “federal parity protections,” according to the administration, aim to ensure that health insurers cover mental health and substance abuse treatment similar to how they cover medical and surgical benefits.
- Similarly, HHS is finalizing a rule that strengthens access to mental health and addiction treatment for people enrolled in Medicaid and the Children’s Health Insurance Program plans. HHS will require those benefits to also offer parity, covering those services similarly to medical and surgical benefits. You can read more about this in a separate CMS announcement issued today.
- SAMHSA is releasing an additional $11 million in funding for states to purchase and distribute naloxone, an opioid overdose reversal drug, and to train first responders and other caregivers to administer the drug.
- The Office of National Drug Control Policy is adding Ohio and Michigan to its High Intensity Drug Trafficking Areas program, which accelerate partnerships between local law enforcement and public health. Those two Midwest states join such other areas as Appalachia, New England, Philadelphia/Camden, New York/New Jersey and Washington/Baltimore.
- The Department of Justice is putting $7 million in funding toward a new COPS (Community Oriented Policing Services) Anti-Heroin Task Force Program, aimed at aiding public safety in investigating the illegal distribution of opioids. Grants will help local law enforcement agencies in states with high rates of admissions for heroin and other opioids.
- Monday, the Department of Agriculture announced the expansion of its $1.4 million Rural Health and Safety Education Grant Program to include addressing the challenges associated with addressing substance abuse in rural communities.
- Finally, HHS is also issuing guidance to federally funded programs on obtaining dollars for the initiation or expansion of syringe services programs for those who inject drugs. Such programs help to educate and prevent the spread of HIV and viral hepatitis through needles.