“Gov. Chris Christie’s presidential opioid commission went out of business Wednesday with 56 recommendations on how to address the crisis and an admonition to Congress to spend the money needed….
Among the new recommendations: providing states with more flexibility to use federal funds to address opioid abuse, launching a media campaign to warn about the dangers of opioid abuse, identifying students who may be at risk of using opioids, giving patients information about the risks of opioids and providing guidelines to doctors, and strengthening efforts to intercept packages of fentanyl and other synthetic opioids.
The panel also called for relaxing limits on insurance coverage of drug abuse treatment, including giving new powers to the Labor Department, which oversees health care plans provided by large employers; taking steps to allow emergency medical technicians to administer naloxone, which can combat opioid overdoses; and establishing drug courts 93 federal judicial districts.
The commission attributed the crisis, in part, to unsubstantiated claims that opioids were a non-addictive way to ease patients’ pain, to pharmaceutical company efforts to promote the use of opioids, to unsavory doctors and pharmacists dispensing the drugs, and inadequate Food and Drug Administration oversight.” (A)
“The commission does not say how much funding implementing its recommendations or tackling the opioid crisis will require — leaving a huge question open, even as it argues that “Congress must act” and “appropriate sufficient funds to implement the Commission’s recommendations.” It also does not call for a new, large investment into drug addiction treatment, as some advocates hoped for.
With its final report, the commission ends months of work in which it met with major stakeholders involved in the crisis, from people struggling with addiction to insurers to pharmaceutical companies.
The question now is whether Trump and Congress will listen to the recommendations.
Here are some of the biggest recommendations in the report: Streamline federal funding for drug addiction: Remove barriers to treatment: Open drug courts in all federal jurisdictions: More opioid prescriber training: Stop evaluating doctors based on pain scores: Allow more emergency responders to deploy naloxone: Tougher prison sentences for fentanyl: A media campaign: (B)
“In declaring the opioid epidemic a public health emergency last week, President Trump promised that the federal government would start “a massive advertising campaign to get people, especially children, not to want to take drugs in the first place.” But past efforts to prevent substance abuse through advertising have often been ineffective or even harmful.
Perhaps the most famous American antidrug advertisement featured a sizzling egg in a frying pan to the sound of ominous music and a stern voice-over warning, “This is your brain on drugs.” A sequel to this ad featured Rachael Leigh Cook smashing an egg and the better part of a kitchen to dramatize the impact of heroin….
Why was the original campaign such a failure? In part it suffered from perverse incentives. Congress provided substantial money for the ads and was intensely interested in them at the height of the so-called war on drugs, creating internal pressure to make the ads appealing to members of Congress. But while ads that lectured or scared people about drugs might have seemed compelling to the modal member of Congress (a 60-year-old white male), they did not necessarily dissuade drug use by adolescents. In some cases, this kind of approach may make drugs more attractive as a sign of rebellion. (C)
“Ironically, just as President Trump hypes his announcement, at the same time – in a position drastically at odds with a plan to combat the opioid crisis – he is still pressuring Congress to make extensive cuts to Medicaid. His tax plan, now being debated by Congress, includes a substantial $1 trillion cut to the program by 2026….
If the President succeeds at dismantling Medicaid, the emergency declaration will do little to reverse America’s upward trend of overdose deaths.
Medicaid has given millions of Americans access to substance use disorder treatment, providing health care coverage to some 3 in 10 people with opioid addiction in 2015. The program covers addiction treatment services, including reimbursement for the life-saving medications buprenorphine, methadone and naloxone. It also helps fund other approaches that we know work – including raising awareness and reducing stigma about drug use and distributing naloxone, an emergency medication to reverse overdose. Currently, over half of the states have increased access for Medicaid enrollees to naloxone. This is not just about the urban centers we serve; a cut to Medicaid is going to be felt in other parts of the country where the epidemic is acute, from New Mexico to New Hampshire.” (D)
“In January 2016, St. Joseph’s began a program to try to decrease the use of opioids in the emergency department, Rosenberg said. Instead of using opioids, physicians used alternative treatments for acute pain. For instance, instead of opioids, doctors used nerve blocking injections with some patients. The approach is proving successful: The emergency department has reported a 58 percent reduction in the use of opioids since the initiative started, Rosenberg said.
St. Joseph’s has also launched a program to help patients addicted to opioids. For patients who have opioid use disorder and want help, St. Joseph’s provides recovery coaches, people who are in recovery themselves. These coaches can help guide people trying to stop using opioids through the recovery process. Not every patient with an opioid addiction opts for this help, but of those who do, 86 percent have achieved long-term recovery, meaning they’ve free of opioid use for at least six months.” (E)
“Over the last two decades, opioids have emerged as the default long-term treatment for chronic pain, largely because there has been little incentive to consider alternatives. Every Medicare plan, for instance, covers common opioids and does not require prior approval. Physicians can just write a prescription and provide their patients with immediate relief.
But opioids are not indicated for all chronic pain problems. One comprehensive report from experts at six U.S. universities found that evidence of the long-term benefits of opioids is “scant” and that many opioid users “continue to have moderate to severe pain and diminished quality of life.”
It’s no wonder that the Centers for Disease Control and Prevention recommends that opioids only be used for three days. Yet prescription rates for opioids have skyrocketed, and the overall prevalence of chronic pain in the United States has stayed roughly the same.
Alternative means of treating chronic pain could break this stalemate.
Take “interventional” pain therapies. These non-surgical procedures target the parts of the body that generate chronic pain — and thus could eliminate patients’ desire for opioids. Popular interventional therapies include the application of electric currents to nerve fibers; the injection of steroids or anesthetic into problematic joints, tissue, and nerves; or treatment with an electric spinal-cord stimulator.
Unlike opioids, these procedures are proven to provide long-term relief. In one study, three-quarters of patients who underwent a procedure that stimulated a specific part of the spinal column reported significant improvements in their level of leg pain over the course of a year. (F)
“On Wednesday, Gary Mendell, founder and CEO of Shatterproof; Dr. Thomas McLellan, former deputy director of the Office of National Drug Control Policy; Chris Hocevar, president (strategy, segments and solutions) of Cigna Corporation; and Mary Ann Christopher, vice president (clinical operations and transformation) of Horizon Blue Cross Blue Shield New Jersey, announced that 16 major healthcare payers would adopt eight “National Principles of Care” for the treatment of addiction….
This group includes six of the largest payers in the United States, covers over 248 million patient lives, and has provided letters of commitment and signed a memorandum of understanding to advance the following eight “National Principles of Care”: Universal screening for substance use disorders across medical care settings; Personalized diagnosis, assessment, and treatment planning; Rapid access to appropriate Substance Use Disorder care; Engagement in continuing long-term outpatient care with monitoring and adjustments to treatment; Concurrent, coordinated care for physical and mental illness; Access to fully trained and accredited behavioral health professionals; Access to Food And Drug Administration (FDA)-approved medications; Access to non-medical recovery support services. (G)
“Cardinal Health has unveiled a big push to combat the opioid epidemic in the four Appalachian states that have been hit hardest by it. The Opioid Action plan is a pilot that officials at the Dublin, Ohio-based company said would bring front-line tools to first responders in Ohio, Kentucky, Tennessee and West Virginia, while increasing its investment in education…
The program will see Cardinal Health purchasing roughly 80,000 doses of overdose reversal drug Narcan Nasal Spray or first responders and law enforcement officers. The company said it would also increase support for drug take-back and education programs, building on similar events held in 13 communities in the four states through the Cardinal Health Foundation’s partnership with the Ohio State University College of Pharmacy. The two organizations teamed up to create Generation Rx, an educational program about the dangers of prescription drug misuse.” (H)
“Scientists across America, including myself, are dedicated to finding non-addictive medications for managing chronic pain and as alternatives to the current opioid medications such as methadone, which are narcotic substitution strategies used to manage opioid addiction. Such non-addictive alternatives include natural plant products, vaccines, chemical and molecular modification of pharmaceutical compounds, repurposing medications currently used for treating other diseases, and state-of-the-art techniques that alter brain activity. We are increasingly hopeful about these non-addictive alternatives. We now need to move them to clinical trials to make sure they work and to promote discovery of other novel treatments.
Most non-traditional approaches lack a path for rapid testing outside the normal pipeline for therapeutic development. The bottleneck in the research-to-treatment pipeline is unknown to most people outside of science, no doubt including to the president. It currently takes over two years for a normal research grant to be funded and initiated. Applications with non-traditional approaches often never even make it to the funding stage. If the research strategy is truly novel, the project will require Food and Drug Administration (FDA) approval for clinical research, which can take an additional year. Then completing the clinical trial itself could last up to five years.
We can’t spend so much time getting these research projects off the ground. According to the Centers for Disease Control and Prevention, 45,788 people died from opioids over a 12-month period ending in January 2017.
In issuing his declaration, Trump initiated several federal initiatives to help people with opioid addiction, such as methadone treatment programs and more flexibility for hospitals in hiring substance abuse specialists. However, these are the same treatments that have been used forever. They are not preventative measures nor do they provide new therapeutic options to the large number of people still not served by the current programs. (I)
“Facebook CEO Mark Zuckerberg said what surprised him most about the U.S. was the scope of the opioid crisis, but Facebook is flooded with illegal ads marketing these pain medications.
Sellers in the U.S. and overseas are using Facebook pages and videos to offer drugs that require a prescription by U.S. law, CNBC reported…
The marketing issue, where users can search for Oxycodone, Hydrocodone, and Percocets, among others, persists weeks after President Donald Trump declared the opioid addiction crisis a public health crisis.
CNBC notes that Facebook users can easily find these drugs by searching the name of the drug followed by “for sell,” rather than “for sale.”
These sorts of pages and posts can evade Facebook detection for months at a time.” (J)
“The economic cost of the opioid epidemic was about $504 billion in 2015, more than six times higher than other studies from previous years, according to a newly released analysis from the White House Council of Economic Advisers (CEA).
This figure accounts for roughly 2.8 percent of gross domestic product. The opioid crisis has garnered the national spotlight, as it has led to a significant uptick in overdose deaths since 1999 and, most recently, was declared a national public health emergency by President Trump…
The council noted that data on fatalities underestimate the number of deaths related to opioids. In 2015, there were more than 33,000 reported opioid-related deaths, but because fatalities are underreported, CEA pegged the number closer to about 41,000 deaths. CEA’s analysis on the economic cost is much higher than previous studies, because it adjusted for underreporting of fatalities and accounted for the value of lives lost using a method federal agencies typically use. Also, previous studies only took into account the cost of prescription painkillers, but CEA’s analysis included illicit opioids, like heroin. (K)
“Now, a handful of doctors and hospital administrators are asking, if an opioid addiction starts with a prescription after surgery or some other hospital-based care, should the hospital be penalized? As in: Is addiction a medical error along the lines of some hospital-acquired infections?
Writing for the blog and journal Health Affairs, three physician-executives with the Hospital Corporation of America argue for calling it just that.
“It arises during a hospitalization, is a high-cost and high-volume condition, and could reasonably have been prevented through the application of evidence-based guidelines,” write Drs. Michael Schlosser, Ravi Chari and Jonathan Perlin.
The authors admit it would be hard for hospitals to monitor all patients given an opioid prescription in the weeks and months after surgery, but they say hospitals need to try.
“Addressing long-term opioid use as a hospital-acquired condition will draw a clear line between appropriate and inappropriate use, and will empower hospitals to develop evidenced-based standards of care for managing post-operative pain adequately while also helping protect the patient from future harm,” said Schlosser in an emailed response to questions.” (L)
“It’s a shame that President Trump’s opioid commission said little about demand-side prevention.
It’s a lot less costly (both in dollars and in lives disrupted) to stop opioid misuse before it starts than to deal with its aftermath. And many prevention programs are cost effective, according to an analysis by the Washington State Institute for Public Policy.
The report from the commission last month emphasized limiting supply much more than demand — targeting opioid sources like prescriptions and the black market. That’s important, too.
But among the report’s 56 recommendations, only two aim to prevent people from seeking out opioids for no medical purpose: an advertising campaign and a structured discussion with a health professional. Neither approach has particularly strong science behind it….
There are many evidence-based prevention programs that could be usefully applied to the opioid crisis. The commission’s report mentions some — including many of those described above — but it stops short of recommending any.” (M)
“President Trump’s opioid commission delivered more than 50 specific ideas to help combat the epidemic, involving more than a dozen agencies. But no one’s in charge of implementing that overall plan — which means no one’s accountable for its progress.
Be smart: Policy-specific “czars” can be a bit of a gimmick. But some experts say there’s a strong case for giving one person the authority to spearhead an opioid response that will need to be far-reaching and multifaceted to be successful….
Why now? Looking at the report from Trump’s opioid commission as well as the steps outside experts have recommended, it’s obvious that this will be a complicated solution with a lot of moving parts.
The Centers for Disease Control and Prevention is generally in charge of monitoring epidemics.
The Food and Drug Administration is re-examining its regulatory rules with an eye toward broader use of medication-assisted therapy, like methadone. It also regulates the design and marketing of opioids that are already on the market.
Some of these products are being prescribed or obtained illegally, and people addicted to opioids frequently turn to illegal drugs like heroin, as well. There are roles here not just for health care agencies, but also law enforcement.
And all of that has to be coordinated not just within the federal government, but with the relevant agencies in all 50 states, as well as tribal authorities.” (N)
“As he emerged from the grip of addiction three years ago, Derek saw how complicated recovery would be: programs to navigate, calls to make, forms to fill out, court dates to attend. All that on top of the emotional and physical strain of parting with the heroin and alcohol that had ruled his life for a dozen years.
“But the 32-year-old counts himself lucky to have had a “recovery coach” guiding him on his journey from treatment to sobriety. The coach, Katie O’Leary, offered a deep understanding, and a motivating example of success: She started her own recovery from heroin addiction seven years ago.
O’Leary, who works for the North Suffolk Mental Health Association, belongs to a new profession whose role is expanding amid the opioid crisis. But as the use of recovery coaches grows, so do the questions: Who are they exactly? What qualifies them to do this work? What are the boundaries of their practice?…
Recovery coaches, or “peer support specialists,” have been around for decades, originally as volunteers who had beat addiction and wanted to help others do the same. In recent years, hospitals, treatment centers, municipalities, and courts have started to pay for their services.
They are seen as peers able to guide and mentor, encouraging people to enter treatment or helping them keep on track in recovery. Usually they are not supposed to provide treatment, and most do not have advanced degrees. But there are no firm statewide rules — and insurance companies do not reimburse for peer recovery services, requiring programs that hire recovery coaches to find other sources of funding. No one even knows how many people call themselves recovery coaches, in Massachusetts or nationwide.
Kristoph Pydynkowski, director of recovery management at the Gosnold treatment center on Cape Cod, welcomes the governor’s proposal to credential recovery coaches, part of a wide-ranging plan to battle opioid addiction.
“It’s a like the Wild West,” he said. “We do need to come up with some standards and best practices.”” (O)
(A) Christie sends Trump final report on opioids with this message: ‘Our people are dying’, by Jonathan D. Salant, http://www.nj.com/politics/index.ssf/2017/11/christie_opioid_commission_passes_baton_to_congres.html#incart_river_index
(B) Here’s what Trump’s opioid commission wants him to do, by German Lopez, https://www.vox.com/policy-and-politics/2017/11/1/16589552/trump-opioid-commission-final-report
(C) Just Say No to Opioids? Ads Could Actually Make Things Worse, by AUSTIN FRAKT and KEITH HUMPHREYS, https://www.nytimes.com/2017/11/01/upshot/why-advertising-is-a-poor-choice-to-tackle-the-opioid-crisis.html
(D) President Trump’s Says He Wants to Stop the Opioid Crisis. His Actions Don’t Match, by Dr. Mary T. Bassett, Dr. Julie Morita and Dr. Barbara Ferrer, http://time.com/5008350/donald-trump-opioid-crisis-actions-words/
(E) Innovative Approaches Needed to Attack Opioid Crisis, by Ruben Castaneda, https://www.usnews.com/news/healthcare-of-tomorrow/articles/2017-11-03/innovative-approaches-needed-to-attack-opioid-crisis
(F) THERE’S ONE SURE WAY TO FIX THE OPIOID CRISIS, by PETER STAATS, http://www.newsweek.com/theres-one-sure-way-fix-opioid-crisis-702009
(G) 16 Insurance Companies Make Commitment To Address Opioid Crisis, by Bruce Y. Lee, https://www.forbes.com/sites/brucelee/2017/11/09/16-insurance-companies-make-commitment-to-address-opioid-crisis/#7fad621279de
(H) Cardinal Health kicks off Opioid Action Program, by DAVID SALAZAR, http://www.drugstorenews.com/article/cardinal-health-kicks-opioid-action-program
(I) Commentary: There’s a Better Way to Fight the Opioid Crisis. Why Aren’t We Focusing On It?, by Yasmin Hurd, http://fortune.com/2017/11/09/opioid-crisis-epidemic-addiction-trump-emergency/
(J) Zuckerberg Surprised by Extent of Opioid Crisis, While Multiple Facebook Pages Sell Opioids, by Katelyn Caralle, http://freebeacon.com/culture/zuckerberg-surprised-by-extent-of-opioid-crisis-while-multiple-facebook-pages-sell-these-drugs/
(K) White House: Economic cost of opioid crisis about $504B, by RACHEL ROUBEIN, http://thehill.com/policy/healthcare/361151-white-house-economic-cost-of-opioid-crisis-about-504b
(L) Should Hospitals Be Punished For Post-Surgical Patients’ Opioid Addiction?, by MARTHA BEBINGER, NPR, November 26, 20176:19 AM ET
(M) Where Is the Prevention in the President’s Opioid Report?, by Austin Frakt, https://www.nytimes.com/2017/11/27/upshot/where-is-the-prevention-in-the-presidents-opioid-report.html
(N) Why Trump may need an “opioid czar”, by Sam Baker, https://www.axios.com/why-trump-may-need-an-opioids-czar-2512794498.html
(O) Questions arise over profession spawned by opioid crisis: recovery coaches, by Felice J. Freyer, https://www.bostonglobe.com/metro/2017/11/28/questions-arise-over-profession-spawned-opioid-crisis-recovery-coaches/eZHhpDq6WYNppqcuaCQNeI/story.html