President’s Opioid Commission Releases Final Report with Recommendations to Address Opioid Epidemic

On November 1, 2017 President Trump’s Commission on Drug Addiction and Opioid Abuse held its fifth and final meeting in conjunction with releasing its Final Report. The Commission, which was established in March, through an executive order signed by the president, heard from invited guests personally impacted by the opioid crisis, including parents, advocates, and substance abuse treatment providers. At the conclusion of the meeting, the Commission voted to accept the Final Report, which includes 56 recommendations to address the opioid epidemic— ranging from increasing access to treatment programs to allowing more emergency responders to administer overdose antidotes.

The report builds upon the Commission’s Interim report, which was released over the summer.  It includes a letter to the president acknowledging the work the Administration has already done to address the opioid epidemic, including the declaration of a public health emergency. It also highlights that one of the most urgent recommendations of the Commission is a national media campaign to fight this public health emergency, as well as the importance of educating youth about the dangers of drugs and addiction. ASA submitted comments to the Commission in response to the Interim report. 

The Commission’s report is comprehensive, focusing on federal funding and programs, opioid addiction prevention, opioid addiction treatment, overdose reversal and recovery, and research and development. Some of the recommendation include:

• Block grant funding for opioid-related and substance use disorder related activities to the states
• That the Office of National Drug Control Policy (ONDCP) establish a coordinated system for tracking all federally-funded initiatives and that ONDCP review is a component of every federal program
• Deployment of screening tools to identify at risk youth who may need treatment
• Collaboration among federal agencies to develop model statutes, regulations and policies that ensure informed patient consent prior to an opioid prescription for chronic pain
• Development of a national curriculum and standard of care for opioid prescribers
• Allow the DEA to require that all prescribers desiring to be relicensed to prescribe opioids show participation in an approved continuing medical education program on opioid prescribing
• Support of and improvements in prescription drug monitoring programs (PDMPs), including establishment and maintenance of a data-sharing hub by the Department of Justice
• Increase electronic prescribing
• That CMS remove pain survey questions entirely on patient satisfaction surveys
• Increased drug take back programs; more hospitals/clinics and retail pharmacies to become year-round authorized collectors and explore the use of drug deactivation bags
• CMS review and modify rate-setting policies that discourage the use of non-opioid treatments for pain
• Enhancement of sentencing penalties for trafficking fentanyl and the use of additional technologies to detect drugs at the border
• Collaboration by federal agencies to incorporate quality measures that address addiction screening and treatment referrals
• Increased authority for the Department of Labor to levy monetary penalties on insurers and funders and ability to institute investigations for parity violations
• That the Department of Justice broadly establish drug courts
• That Congress provide additional resources the National Institutes of Health (NIH) to fund research on pain managements and addiction
• That commercial insurers and CMS fast-track creation of Healthcare Common Procedure Coding System (HCPCS) codes for FDA-approved technology-based treatments, digital interventions, and biomarker-based interventions.

In conjunction with the release of the Commission’s report, the Centers for Medicare and Medicaid (CMS) also announced a new Medicaid policy, including approval of demonstration projects that increase access to treatment for opioid use disorder and other substance use disorders (SUD). Through this updated policy, states will be able to pay for a fuller continuum of care to treat SUD, including critical treatment in residential treatment facilities that Medicaid is unable to pay for without a waiver.

ASA has worked closely with partner organizations and other medical societies, including the AMA Opioid Task Force, to explore solutions to the opioid epidemic. Some key activities include increasing physicians’ use of prescription drug monitoring programs (PDMPs), working to expand access to naloxone and promoting education of effective, evidence based prescribing. ASA has also partnered with the hospitals of Premier Inc. to launch a national opioid safety pilot. The pilot seeks to decrease opioid use during and after surgery as well as at discharge, by employing multimodal therapy, through evidence-based medical practices and patient education

ASA is looking forward to identifying opportunities to work with the Administration as it begins to implement the recommendations in the Commission’s Final Report to ensure multimodal and multidisciplinary pain management strategies are advanced, including non-opioid therapies.