“In the decades since the crack epidemic, our country has learned an important lesson: there is no arresting our way out of drug addiction. The failed “War on Drugs” put too many people in jail instead of treatment, a mistake that cost us countless lives and taxpayer dollars. Now, we’re facing a new drug crisis — and this time, we have to do better.
That said, the U.S. House of Representatives’ votes this month on a number of bills aimed at addressing the national opioid crisis should come as welcome news. Some of these measures, such as those to expand access to treatment and better monitor opioid prescriptions, are steps in the right direction. Yet those who have experienced this crisis firsthand caution leaders in Washington against thinking that addressing the opioid crisis means reverting to the “tough on crime” thinking of the 1980s. With tens of thousands of American lives on the line, we can’t afford to repeat that mistake. As Congress considers proposals to address this epidemic, Dayton and communities across the country should serve as models for the kind of support needed and approaches that emphasize treatment over punishment.” (A)
“The House spent much of the last two weeks passing dozens of bills aimed at addressing the opioid crisis, an effort top lawmakers from both parties have long identified as a priority.
Many are consensus proposals, though a few have generated controversy. Some are substantial in their scope, though many fund pilot programs or studies, or enact grants for which funding will expire within years.
Outside experts, while applauding Congress for its focus on the issue, say they believe the current package fails to match the scope of the current crisis…
The House is expected to finish its opioids work this week. Here’s a look at some of the most impactful bills, and which proposals or policy ideas didn’t make the cut.
WHAT’S IN THE PACKAGE: 1. Evidence-based treatment. 2. Waiving the IMD exclusion. 3. Expanded access to buprenorphine. 4. A movement away from opioids for pain treatment. 5. Changes to medical privacy laws stricter privacy standards have expressed concern that the change could prevent some individuals from seeking treatment.
WHAT’S NOT: 1. Harm reduction. 2. Methadone treatment expansion for Medicare and Medicaid. 3. More parity enforcement. 4. Mandatory prescriber education” (B)
“New York doctors who accepted speaking fees, honoraria, meals and other forms of payment from opioid manufacturers started writing more prescriptions for the narcotic painkillers, according to an analysis from the New York State Health Foundation.
When comparing physicians in similar specialties who historically prescribed similar amounts of opioids, the researchers found that those who started accepting pharma payments increased their opioid prescribing rates significantly more over time than those who did not…
A group of doctors who started receiving opioid-related payments in 2014 increased their prescribing rates by 37.2% from the previous year and another 24.7% between 2014 and 2015, according to the report. By contrast, a group of similar doctors who did not receive opioid-related payments in those years increased their prescribing by 15.6% in 2014 and just 1.9% in 2015.
Pharmaceutical companies paid a total of $196.4 million to New York doctors during the study period of August 2013 to December 2015. During that time 3,389 New York doctors received $3.6 million in payments specifically related to opioids. Among those doctors, the average total amount received was about $1,000.
The largest share of payments, 73.1%, came from speaking fees and honoraria. However, the most frequent payments, 87.7%, were for food and beverage…” (C)
“Dr. Elinore McCance-Katz, the Trump administration’s director of the Substance Abuse and Mental Health Services Administration, helped pioneer opioid addiction treatment with buprenorphine in clinical trials in the 1990s. She also helped create the training for doctors who want to prescribe it. What follows is a condensed interview with her.
Do you think the number of primary care providers who prescribe buprenorphine is growing fast enough? What I will say is that we have a lot of work to do. When we first thought about this treatment, it was really thought about as a way to integrate treatment of opioid use disorders, opioid addiction, into primary care. Because we know that many, many people with opioid problems have other medical problems, and sometimes they have psychiatric problems, too. Psychiatry has had much more uptake on this than has primary care. But the idea was you eliminate the stigma by just having them be another patient in the waiting room. That was the hope.
So why are primary care providers still generally reluctant to provide addiction treatment? In recent years, medical schools have been putting more hours of training on addiction in place. But for probably the majority of physicians practicing now, we had very little to no exposure to it in medical school, or even in residency. If you don’t learn how to treat what is a complex disorder, then you feel uncomfortable taking it on. And because these disorders often involve psychosocial problems, many primary care doctors feel they may not have the resources to fully assist people. I talked to my own primary care provider about it and she said, ‘You know, Ellie, I don’t think I’m the right person.’” (D)
“A newborn had arrived for his checkup, prompting Dr. Nicole Gastala to abandon her half-eaten lunch and brace for the afternoon crush. An older man with diabetes would follow, then a pregnant teenager, a possible case of pneumonia and someone with a rash.
There were also patients on her schedule with a problem most primary care doctors don’t treat: a former construction worker fighting an addiction to opioid painkillers, and a tattooed millennial who had been injecting heroin four times a day.
Opioid overdoses are killing so many Americans that demographers say they are likely behind a striking drop in life expectancy. Yet most of the more than two million people addicted to opioid painkillers, heroin and synthetic fentanyl get no treatment. Dr. Gastala, 33, is trying to help by folding addiction treatment into her everyday family medicine practice. She is one of a small cadre of primary care doctors who regularly prescribe buprenorphine, a medication that helps suppress the cravings and withdrawal symptoms that plague people addicted to opioids. If the country is really going to curb the opioid epidemic, many public health experts say, it will need a lot more Dr. Gastalas.” (E)
“What’s the right painkiller prescription to send home with a patient after gallbladder surgery or a cesarean section? That question is front and center as conventional approaches to pain control in the United States have led to what some see as a culture of overprescribing, helping spur the nation’s epidemic of opioid overuse and abuse.
The answer isn’t clear-cut. Surgeon Marty Makary wondered why and what could be done. So, Makary, a researcher and a professor of surgery and health policy at Johns Hopkins School of Medicine in Baltimore, took an innovative approach toward developing guidelines: matching the right number of opioid painkillers to specific procedures.
After all, most doctors usually make this decision based on one-size-fits-all recommendations, or what they learned long ago in med school…
“No one should have 50 tabs sitting in their medicine cabinet” for acute pain, says Dr. Marty Makary, who’s leading an effort to curb overprescribing by offering procedure-specific guidelines for opioid painkillers. (Courtesy of Johns Hopkins Medicine)” (F)
“From 1996 to 2002, Purdue pursued nearly every avenue in the drug supply and prescription sales chain—a strategy now cast as reckless and illegal in more than 1,500 federal civil lawsuits from communities in Florida to Wisconsin to California that allege the drug has fueled a national epidemic of addiction…
The marketing files show that about 75 percent of more than $400 million in promotional spending occurred after the start of 2000, the year Purdue officials told Congress they learned of growing OxyContin abuse and drug-related deaths from media reports and regulators.
These internal Purdue marketing records show the drugmaker financed activities across nearly every quarter of medicine, from awarding grants to health care groups that set standards for opioid use to reminding reluctant pharmacists how they could profit from stocking OxyContin pills on their shelves…
Purdue hoped to grow into one of the nation’s top 10 drug companies, both in sales and “image or professional standing,” according to the documents; OxyContin was the means to that end…
Purdue bombarded doctors and other health workers with literature and sales calls. Records show that in 1997 the company budgeted $300,000 for mailings to doctors who prescribed opioids liberally, based on sales data that drug companies purchase. The mailers recommended OxyContin for “pain syndromes,” including osteoarthritis and back pain. It added $75,000 for mailings “to keep in touch with our best customers for OxyContin to ensure they continue prescribing it.”” (G)
“Mandy has now been in recovery from her opioid addiction for more than two months — and she’s ready to keep that going. But the 29-year-old in the Chicago area is now dealing with a big obstacle: her health insurer.
Mandy, who asked I use only her first name, said she struggled with addiction for six years. It started with back pain, which a doctor tried to treat with Vicodin…
In March, Mandy decided she had enough. She got into an intensive outpatient addiction treatment program for eight weeks and was prescribed buprenorphine, a medication for opioid addiction that staves off withdrawal and cravings without producing the kind of high that, say, heroin or painkillers might. She’s remained on the medication as she’s transitioned to less intensive treatment.
There’s just one problem: Her insurer, Blue Cross and Blue Shield of Illinois, won’t pay for the buprenorphine. That’s left Mandy to foot the bill. Her latest bill — for a 28-day supply — was priced at $294 out of pocket, although she got it down to $222.69 with a discount. With the discount, similar bills throughout a full year would add up to nearly $2,900.” (H)
“Within the next two months, anyone who gets an acute opioid prescription filled at a Walmart will be limited to a seven-day supply of the medication, part of the company’s effort to curb the number of pills being sold illegally on the street.
Walmart announced last week it would join CVS Caremark, the nation’s largest pharmacy chain, to cap prescriptions, a move Walmart said put it in line with federal guidelines…
Walmart’s policy, which will be put into effect within 60 days, also mirrors efforts by several states that limit acute opioid prescriptions to seven days, including a bill before Pennsylvania lawmakers that would impose the one-week limit.” (I)
Dr. Kenneth Choquette, a Coordinated Health pain management specialist and physician for three decades, said he learned of Walmart’s new prescription policy from patients who use opioids and were alarmed by it…
“The addict is going to find pills or other methods no matter what,” Choquette. “But these limits by industries and insurance companies doesn’t fix anything other than to greatly inconvenience those who are already suffering and yet taking their medication properly under the care of a physician.”
Dr. John Gallagher, chairman of the Pennsylvania Medical Society’s opioid task force, said he’s open to any ideas that may help slow the opioid epidemic, but isn’t sure if limiting pain medication is the answer.
“The arbitrary refusal to fulfill a physician’s treatment plan while not cognizant of the complete clinical situation may not be appropriate,” Gallagher said. He said the better answer may be to develop clinical practical guidelines and consult with the prescribing physician.
Somewhere along the line, you need to pick a number and say this number of pills is enough to get by, but not get someone addicted. — State Sen. Gene Yaw, sponsor of a bill to limit opioid prescriptions to seven days
Pennsylvania is one of 19 states that puts limits on opioid prescriptions, including one that the dosage cannot exceed 120 milligrams of morphine or morphine equivalent per day, according to the state Department of Health. The new guidelines from Walmart limit the dosage to no more than 50 mg per day.” (J)
“Health insurer Cigna wants to cut the number of opioid overdoses among its customers by 25% within three years.
In particular, the Bloomfield, Connecticut-based company plans to address overdoses by focusing new drug prevention and treatment efforts in targeted cities around the U.S. The company also said it will work with employers, customers, clinicians, pharmacists and community-based organizations to reach its goal by December 2021.
The announcement comes just a few months after Cigna reported it reduced opioid use by 25% among its customers. However, Cigna claims data showed that despite a reduction in the number of prescriptions, opioid overdoses continue to rise.” K)
“But treatment is not the primary focus of this crop of (congressional) bills. Instead, a large number address various matters related to the prescribing of drugs; the tracking of prescribing; and the packaging and disposal of medications. Many of these measures could be helpful in preventing new cases of addiction: A recent study cited by the Department of Health and Human Services suggests that over half of those in treatment for opioid-use disorders began by using prescription medications…
Another missed opportunity, addiction experts said, is the legislative strategy to encourage creation of more treatment options for patients who need them. Earlier legislation, including the recent big spending deal passed by Congress, created short-term state grants for local anti-opioid priorities. But what health care providers and other entrepreneurs really need is a more permanent source of funding, so that those setting up clinics or companies will know they can remain in business over the long term, said Caleb Alexander, a professor at the Johns Hopkins Bloomberg School of Public Health. The shorter-term grant programs may not provide the nudge, he said.
“States are getting $500 million here or $200 million there,” he said. “At any given moment, it’s unclear whether the rug is going to be pulled out from under them.”” (L)
“For at least six months, staffers in the Office of National Drug Control Policy — often political appointees in their 20s — have crossed 17th Street, entered the Eisenhower Executive Office Building, and sat through weekly meetings of an “opioids cabinet” chaired by Kellyanne Conway.
Then they have returned to their desks and reported back to veteran career staff — who have listened, often with disappointment, to the ideas proposed by Conway and Katy Talento, a domestic policy adviser…
Frustrations with the meetings, according to officials familiar with them, are symptomatic of a broader issue: A year and a half into the Trump administration, it remains unclear who, besides Conway, is coordinating U.S. drug policy in the midst of an opioid crisis…
“I don’t understand why Trump and Kelly haven’t gotten some major figure — medical, political, you name it — to run the operation, and then funded it,” said Barry McCaffrey, formerly a four-star Army general who served as drug czar during the Clinton administration, referring to John Kelly, the president’s chief of staff.
Others inside and outside the administration have expressed concern that the agency is being used as a pasture for former Trump campaign workers and administration officials who have left previous jobs. The White House strongly contested that assertion, pointing to recent personnel moves as a sign the administration was sending valued talent to the drug policy office.” (M)
“The National Institutes of Health (NIH) has outlined its strategy to combat the opioid addiction crisis and improve pain management.
“Like most other pioneering scientific initiatives, HEAL will focus on a range of objectives, from short-term goals to research priorities that will take longer to bear fruit. Yet, all will be aimed at the same ultimate vision: a nation of people with far less disabling pain and opioid addiction,” they say.
The HEAL initiative will focus on two main areas: improving treatments for patients who misuse or are addicted to opioids and enhancing strategies for pain management.
Methadone, buprenorphine, and naltrexone are effective for opioid use disorder (OUD), but only a small percentage of people in the United States who would benefit receive these medications, Collins and coauthors point out. Even among those who start these medications, about half will relapse within 6 months. Research is needed to reformulate these medications to improve adherence, as well as to develop new, more flexible therapies for people with OUD…
Ending addiction long-term will also require finding new ways to effectively manage acute and chronic pain, they note. Therefore, the second major focus of the HEAL research plan includes a “coordinated approach to discover and validate new biologic targets for effective, nonaddictive pain management, as well as accelerate the process of discovery to develop therapies aimed at these targets,” Collins and coauthors say.” (N)
“The Addiction Solutions Campaign recently released a comprehensive policy document with recommendations for how funds from a settlement of the opioid litigation should be invested to address the epidemic.
• Begin with an inventory of community resources. The opioid epidemic resulted from broad national forces, but sustainable solutions must consider a local community’s strengths and weaknesses. This community inventory would include a list of all local prevention, treatment, recovery and harm reduction programs. This information will expose gaps in the system and inform a community response that builds on unique capacity in a local area.
• Second, examine the data. Local public health resources, as well as local public safety data, can help inform a community-based solution. For example, if prescribing data from the Centers for Disease Control and Prevention indicates that a county has higher-than-average rates of opioid prescribing, local prescribers may require training in pain management as well as in how to screen and care for people with substance-use disorders. In addition, a higher-than-average rate of overdoses in an area could indicate a need for community-based naloxone distribution.
• Third, follow the science. There is an extensive body of research on how to prevent, treat and care for people with substance-use disorders. The 2016 Surgeon General’s Report on Alcohol, Drugs and Health provides an excellent overview of evidence-based policies. The research contained in this report, along with the Addiction Solutions Campaign recommendations, should guide a local approach.” (O)
“Three years ago, with the opioid epidemic taking off, police officers in this affluent Atlanta suburb noticed an uptick in overdoses. Sgt. Robert Parsons rushed to equip his fellow officers with a lifesaving tool: the opioid antidote naloxone.
He stumbled across a drug company that was donating free cartons of naloxone auto-injectors to police agencies, and placed an order online. Within months, he had revived a man. But the following spring, when another batch of naloxone arrived, he was surprised to find that the injectors were set to expire in four months.
“You don’t know what you’re getting until the boxes show up,” said Parsons, the Dunwoody department’s naloxone coordinator. “You might as well begin filling out the paperwork [right away] to get them replaced.”..
“Is the practice of giving out soon-to-be expired drugs ethical? The answer is clearly no.” (P)
“As legislation to address the opioid epidemic gains momentum, drug makers, insurers, and other interest groups are engaging in a concerted drive to tailor the bills to their liking.
The effort, in some cases, has resulted in lawmakers softening, or entirely backing off, some of their most far-reaching proposals.
Members of Congress have advanced dozens of bipartisan bills that advocates say are needed, commonsense steps to address the public health crisis. Later this month, the House is likely to consider legislation that would speed approvals for non-opioid painkillers, strengthen drug enforcement programs, improve care for children impacted by addiction, strive to reduce prescription levels, and improve prescription monitoring programs.
But not all of the proposals have gone unopposed. The pharmaceutical trade group PhRMA, the American Medical Association, and a major drug distributor are among a handful of players maneuvering to shape the legislation, according to a review of lobbying disclosures by STAT and interviews with Capitol Hill aides, lawmakers, and lobbyists.
“This is the big time, and the price of working on major legislation is that insurance companies and pharmaceutical companies get involved,” said Andrew Kessler, a longtime advocate on addiction treatment issues who represents a number of behavioral health associations and treatment providers. “We’ve got work to do, they’ve got work to do, and let’s hope we’re better than they are.”.. (Q)
“Analyzing wastewater before it converges and mixes downstream at treatment facilities permits Biobot to measure drug use of not only an entire city but also of specific locations, down to areas of a few thousand people. The more precise method could enable city officials to first pinpoint communities that need interventions, like substance abuse programs, and to later measure the success of those programs in lowering drug use.
“Going down into the sewer system below the city is the most valuable approach compared to just looking into the influx of a big wastewater treatment plant,” said Carsten Prasse, assistant professor in the department of environmental health and engineering at Johns Hopkins University.” (R)
(A) Opioid epidemic requires a new perspective on addiction treatment and new solutions, by Nan Whaley, https://www.usatoday.com/story/opinion/2018/06/22/opioid-epidemic-needs-laws-quality-treatment-instead-punishment-column/714159002/
(B) What’s in the House Bills to Address the Opioid Crisis—and What’s Not, by Lev Facher, https://www.scientificamerican.com/article/whats-in-the-house-bills-to-address-the-opioid-crisis-and-whats-not/
(C) Docs paid by pharma increased opioid prescriptions by 37%, report finds, by Caroline Lewis, http://www.crainsnewyork.com/article/20180612/HEALTH_CARE/180619974/docs-accepting-pharma-payments-increased-opioid-prescriptions-by-37-report-finds
(D) The Trump Appointee Who’s an Addiction Specialist, by Abby Goodnough, https://www.usatoday.com/story/opinion/2018/06/22/opioid-epidemic-needs-laws-quality-treatment-instead-punishment-column/714159002/
(E) When an Iowa Family Doctor Takes On the Opioid Epidemic, by Abby Goodnough, https://www.nytimes.com/2018/06/23/health/opioid-addiction-suboxone-treatment.html
(F) Doling Out Pain Pills Post-Surgery: An Ingrown Toenail Not The Same As A Bypass, by Julie Appleby, https://khn.org/news/doling-out-pain-pills-post-surgery-an-ingrown-toenail-not-the-same-as-a-bypass/?utm_source=STAT+Newsletters&utm_campaign=62f7742e05-MR_COPY_09&utm_medium=email&utm_term=0_8cab1d7961-62f7742e05-149527969
(G) How America got hooked on a deadly drug, https://www.fiercehealthcare.com/hospitals-health-systems/how-america-got-hooked-a-deadly-drug?mkt_tok=eyJpIjoiTkRWaU9EUTBNRFkxTXpGbSIsInQiOiJ2YmRYTlFIZFwvT05Bc3BUYVVPcFp4TE9ZeGRGSE5FeWJZN2JBNk9QeXljZTBPTEljTjVZYlNOVGFrMTN0blwvc01RdlI0M01VVEdBTUF1TnRQdmhNeTBHRTFiWlBnazRVNWFBQUw1R0Y3UnE5MnpQcjB0Uit1TXJkaG5DQWc5V21DIn0%3D&mrkid=654508
(H) She paid nothing for opioid painkillers.Her addiction treatment costs more than $200 a month., by German LopezJun, https://www.vox.com/science-and-health/2018/6/4/17388756/opioid-epidemic-health-insurance-buprenorphine
(I) Walmart is limiting opioid prescriptions. Will it help stop the addiction crisis?, by Pamela Lehman, http://www.mcall.com/news/breaking/mc-nws-walmart-limits-opioid-prescriptions-20180514-story.html
(J) Walmart is limiting opioid prescriptions. Will it help stop the addiction crisis?, by Pamela Lehman, http://www.mcall.com/news/breaking/mc-nws-walmart-limits-opioid-prescriptions-20180514-story.html
(K) Cigna announces goal to cut customers’ opioid overdoses by 25% by end of 2021, by Tina Reed, https://www.fiercehealthcare.com/payer/cigna-announces-goal-to-cut-customers-opioid-overdoses-by-25-by-2022
(L) Congress Is Writing Lots of Opioid Bills. But Which Ones Will Actually Help?, by Margot Sanger-Katz, https://www.nytimes.com/2018/06/20/upshot/congress-is-writing-lots-of-opioid-bills-but-which-ones-will-actually-help.html
(M) Empty desks, squabbles, inexperienced staff: Exactly who is coordinating White House drug policy?, by Lev Facher, https://www.statnews.com/2018/06/18/opioid-crisis-response-ondcp/?utm_source=STAT+Newsletters&utm_campaign=efc86e0f32-MR_COPY_01&utm_medium=email&utm_term=0_8cab1d7961-efc86e0f32-149527969
(N) NIH Outlines New Game Planto Combat Opioid Crisis, by Megan Brooks, https://www.medscape.com/viewarticle/898045
(O) A Community Framework for Addressing the Opioid Epidemic, by Regina LaBelle, http://www.governing.com/gov-institute/voices/col-community-framework-addressing-opioid-epidemic-litigation-funds.html
(P) Donations of $4,500 overdose antidote were PR gold for drug maker — but some kits were close to expiring, by Max Blau, https://www.statnews.com/2018/06/18/kaleo-evzio-donations-near-expiration/?utm_source=STAT+Newsletters&utm_campaign=efc86e0f32-MR_COPY_01&utm_medium=email&utm_term=0_8cab1d7961-efc86e0f32-149527969
(Q) As opioids legislation gains steam, efforts to address crisis collide with moneyed interests, by Lev Facher, https://www.statnews.com/2018/06/07/opioid-crisis-legislation-moneyed-interests/?utm_source=STAT+Newsletters&utm_campaign=cd402f140c-MR_COPY_09&utm_medium=email&utm_term=0_8cab1d7961-cd402f140c-149527969
(R) Scientists can track the spread of opioids in sewers. But do cities want to know what lies below?, by Justin Chen, https://www.statnews.com/2018/06/26/wastewater-epidemiology-biobot-opioids/?utm_source=STAT+Newsletters&utm_campaign=242ec602b8-MR_COPY_08&utm_medium=email&utm_term=0_8cab1d7961-242ec602b8-149527969