WASHINGTON — It’s clear that America’s growing opioid epidemic is getting worse. Last month President Trump stopped short of declaring the crisis a national emergency and directed the Department of Health and Human Services to declare the opioid crisis a public health emergency instead.
Though this less urgent designation puts Congress in charge of dispensing funds, whereas a national emergency declaration would have made them available immediately — as in a natural disaster — the White House action is likely to free up money to expand medical services, especially in rural areas where doctors and treatment are often lacking.
Prior to that declaration, the National Association of Chain Drug Stores sent a letter to President Trump, as well as others in the administration and members of Congress, expressing its support for four new public policy proposals intended to build on existing collaborative efforts to address the opioid abuse epidemic while providing quality patient care.
The four new public recommendations favored by NACDS include:
• Legislate a seven-day supply limit for initial opioid prescriptions issued for acute pain. This limit, according to NACDS, is consistent with the Centers for Disease Control and Prevention (CDC) Guideline for Prescribing Opioids for Chronic Pain. CDC’s clinical evidence suggests that a greater amount of initial opioid exposure is associated with a greater risk for long-term use and addiction. Nearly 20 states already have taken action, and federal legislation is needed, the associations says, for consistent patient care.
• Legislate a requirement that all prescriptions be issued electronically, with limited exceptions. E-prescribing, in the view of NACDS, enhances security and curbs fraud, waste and abuse. Drug Enforcement Administration e-prescribing requirements call for two-factor authentication, reducing the likelihood of fraudulent prescribing. Federal and state action would be timely, as e-prescribing of controlled substances has only been legal in all 50 states since September 2015. Only 14% of controlled substance prescriptions are issued electronically, according to NACDS.
• Create a national prescription drug monitoring program (PDMP) through collaboration. Most states use data to help identify and prevent drug abuse and diversion, NACDS says, but program variances limit their effectiveness. It is necessary to harmonize state requirements for reporting and accessing PDMP data, in the association’s estimation, and to create one system with unified expectations by health care providers and law enforcement.
• Provide manufacturer-funded mail-back envelopes for unused opioid drugs, available to patients at pharmacies upon request. As it stands now, many pharmacies offer disposal programs as appropriate by community and by store, NACDS says, adding that a program featuring mail-back envelopes provides an option that is universally workable. State legislation could facilitate a mail-back program.
“These four integrated public policy strategies would further reduce the volume of unneeded and unused opioid medications entering the public domain, and reduce the chances that they fall into the wrong hands — while taking into account the needs of those most severely affected by chronic pain as a result of cancer and other serious illnesses,” said NACDS president and chief executive officer Steve Anderson in releasing the letter. “The fact that these public policy proposals are gaining traction among those in the health care and enforcement communities reflects that much-needed consensus may be starting to build for additional and sound approaches to this epidemic.”
The new proposals build on current pharmacy initiatives and prior comments submitted to the President’s Commission on Combating Drug Addiction and the Opioid Crisis, NACDS notes, such as DEA compliance programs, drug disposal options, pharmacy security initiatives, naloxone access, and stopping illegal online drug sellers and rogue clinics.
The letter also focused on the need to stop the flow of synthetic opioids entering the country; the need to continue to advance prescriber education tools through the FDA’s Risk Evaluation and Mitigation Strategies for opioids; the need for a one-document solution for patient medication information; and the need for enhanced access to treatment for those with substance abuse disorders.