President’s opioid crisis commission issues report

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Pharmacy industry stakeholders applaud recommendations

WASHINGTON — The President’s Commission on Combating Drug Addiction and the Opioid Crisis has issued its final report, which includes 56 recommendations to the Trump administration to help fight opioid abuse.

President Donald Trump formed the presidential commission, chaired by New Jersey Gov. Chris Christie (R.), in a March 29 executive order as a way to assess drug addiction and abuse in the United States and identify actions that the federal government could take. The commission, which held its first meeting in June, on Wednesday voted on its final report of recommendations to the president.

Just days earlier, Trump formally declared the opioid epidemic a national public health emergency, following through on a vow he made over the summer to do so.

“You have made fighting the opioid epidemic a national priority, Mr. President. And the country is ready to follow your lead. Now we urge Congress to do their constitutionally delegated duty and appropriate sufficient funds (as soon as possible) to implement the commission’s recommendations,” Christie said in a Nov. 1 letter to Trump presenting the commission’s final report. He added, “175 Americans are dying a day. Congress must act.”

Topping the list of recommendations is the creation of a national multimedia campaign, including “aggressive television and social media outreach,” emphasizing the dangers of opioid painkillers and addiction to youth, removing the stigma of substance abuse and highlighting health risks associated with opioid use.

The commission also called for better education about the hazards of opioid medications for middle school, high school, and college students, especially through trained professionals like nurses and counselors who can assess at-risk kids.

“Today, only 10.6% of youth and adults who need treatment for a substance use disorder receive that treatment. This is unacceptable,” Christie wrote in the letter. “Too many people who could be helped are falling through the cracks and losing their lives as a result.”

Red tape has also been a problem in getting federal funding support more quickly and effectively to state governments, according Christie. To that end, the commission recommended that Congress and the administration block grant federal funding for opioid-related and SUD-related activities to the states.

“There are multiple federal agencies and multiple grants within those agencies that cause states a significant administrative burden from an application and reporting perspective. Money is being wasted, and accountability for results is not as intense as it should be,” Christie explained. “Block granting them would allow more resources to be spent on administering life-saving programs. This was a request to the commission by nearly every governor, regardless of party, across the country.”

Chris Christie_President's Opioid Crisis Commission

New Jersey Gov. Chris Christie chaired the president’s opioid crisis commission since its formation in March.

In what it called a “disturbing trend,” the commission cited federal health care reimbursement policies that incentivize the prescribing of opioids and limit access to nonaddictive treatments for pain as well as addiction treatment and medication-assisted treatment.

“The commission heard from many innovative life sciences firms with new and promising products to treat patients’ pain in non-addictive, safer ways. But they have trouble competing with cheap, generic opioids that are so widely used,” Christie wrote. “We should incentivize insurers and the government to pay for non-opioid treatments for pain beginning right in the operating room and at every treatment step along the way.”

In some cases, he added, nonaddictive pain medications are bundled in federal reimbursement policies so doctors and hospitals and doctors aren’t covered to prescribe non-opioid alternatives. “These types of policies, which the federal government can fix, are a significant deterrent to turning the tide on the health crisis we are facing. We urge you to order HHS to fix it,” he stated.

Other commission recommendations included the following:

• The Centers for Medicare & Medicaid Services (CMS) should eliminate pain questions its requirement that hospitals survey discharged patients. “The commission recommends that CMS remove pain questions entirely when assessing consumers so that providers won’t ever use opioids inappropriately to raise their survey scores. We urge you to order HHS to do this immediately,” Christie explained. “The expectation of eliminating a patient’s pain as an indication of successful treatment … was cited as a core cause of the culture of overprescribing in this country that led to the current health crisis. This must end immediately.”

• Give the Department of Labor more authority to regulate the health insurance industry. “The health insurers are not following the federal law requiring parity in the reimbursement for mental health and addiction. They must be held responsible,” Christie said.

• Identify ways to reduce the supply of illicit opioids and bolster enforcement. This includes recognizing the proliferation of synthetic opioids such as fentanyl, stepping up penalties for trafficking of fentanyl and fentanyl analogues, and additional technologies and drug detection methods to intercept fentanyl before enters the country.

“The commission is confident that, if enacted quickly, these recommendations will strengthen the federal government, state and local response to this crisis,” Christie concluded in the letter. “But it will take all invested parties to step up and play a role: the federal executive branch, Congress, states, the pharmaceutical industry, doctors, pharmacists, academia and insurers. The responsibility is all of ours.”

Other members of the commission are Massachusetts Gov. Charlie Baker (R.), North Carolina Gov. Roy Cooper (D.), former congressman Patrick Kennedy (D., R.I.), Florida Attorney General Pam Bondi (R.) and Professor Bertha Madras of McLean Hospital and Harvard Medical School.

“This tragedy has devastated Americans and America’s communities for far too long. The president has prioritized these crucial issues by declaring a nationwide public health emergency,” the White House said in a statement. “The President’s Commission on Combating Drug Addiction and the Opioid Crisis has submitted its final report, recommending how the federal government can address the drug addiction and opioid crisis. We are grateful for the commission’s extensive work since March and look forward to reviewing these recommendations as the entire Administration continues to work to lessen drug demand and the opioid crisis.

The commission’s final report was applauded by pharmacy industry stakeholders.

“NACDS appreciates and commends the work of the President’s Commission on Combating Drug Addiction and the Opioid Crisis, which will serve as a catalyst for further collaboration and action in helping to create solutions to this epidemic,” Steve Anderson, president and chief executive officer of the National Association of Chain Drug Stores, said in a statement. “Consistent with pharmacy’s ongoing work to bring about a simultaneous zero-tolerance for abuse and 100% commitment to patient care, NACDS contributed its perspective to the commission’s work. We appreciate that many concepts urged by NACDS and by others have been incorporated into the report.”

John Gray, president and CEO of the Healthcare Distribution Alliance, stated, “We commend the commission for its work over the past several months to identify comprehensive solutions to address the opioid epidemic. Our industry is strongly committed to working with the public and private sectors to advance meaningful reforms at both the state and federal levels to reduce the prevalence of overprescribing, increase awareness of proper use and disposal of opioids among patients and families, and ensure individuals with legitimate pain needs have access to safe and effective treatments.”

The National Community Pharmacists Association said the commission’s final report endorses several concepts that it supports, including prescriber education for controlled substances, expanded access to the overdose-reversing drug naloxone, greater availability to medication-assisted therapy, enhancing the scope and functionality of prescription drug monitoring programs, and more scrutiny and restrictions on certain controlled substances delivered through the mail.

“I’m heartened that the just-released report of the president’s opioid commission includes many of the ideas NCPA proposed in recommendations to the U.S. Department of Health and Human Services in August and to the U.S. Senate Committee on Health, Education, Labor & Pensions in September,” commented NCPA CEO B. Douglas Hoey. “Independent community pharmacists share the American public’s concern about the opioid crisis. We are on the frontlines of this battle and are committed to doing everything we can to help.”



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