Opioids: a National Epidemic; it's Worse Than We Thought
Written by Editor   
Friday, August 11, 2017 12:17 PM

Earlier in August, the president’s Commission on Combating Drug Addiction and the Opioid Crisis urged President Trump to declare the opioid crisis a national emergency in order to expedite emergency funding and resources to places hardest hit by the crisis. 

On August 8, Health and Human Services Secretary Tom Price, MD, stated “We believe that, at this point, that the resources that we need, or the focus that we need to bring to bear to the opioid crisis at this point can be addressed without the declaration of an emergency.”  Such emergencies are used in response to “specific area” and a “time-limited problem,” Price reported.

On August 10, President Trump declared the opioid crisis a national emergency. “The opioid crisis is an emergency, and I'm saying officially right now it is an emergency. It's a national emergency. We’re going to spend a lot of time, a lot of effort and a lot of money on the opioid crisis. …We're going to draw it up and we're going to make it a national emergency. It is a serious problem, the likes of which we have never had."

The declaration would release millions in emergency funding and resources that could quickly be distributed to states. It would allow states and localities to access money in the federal Disaster Relief Fund and allow temporary waivers from many rules.

More than one out of three average Americans used a prescription opioid painkiller in 2015. Opioids directly killed more than 33,000 people in 2015.  The opioid epidemic is worse, however, than previously reported.  A recent study published in the American Journal of Preventive Medicine indicates that we’re still underestimating the size of the opioid epidemic. A big chunk of death certificates that list overdose as a cause of death don’t report what drug was to blame. The rate of the discrepancies varied dramatically from state to state. This study corrected the data by applying models to each case.  The corrected results increased the number of opioid deaths nationally by 24% over what was previously reported–11.2 per 100,000 rather than 9.0.  Heroin was deaths were increased by 22%–4.0 per 100,000 rather than 3.3. 

There is a growing body of research validating the effectiveness of chiropractic services.  Many respected health care organizations now recommend non pharmaceutical pain relief such as chiropractic and its drug-free approach.  The American Chiropractic Association (ACA) encourages patients and health care providers to first exhaust conservative forms of pain management, when appropriate, before moving on to riskier, potentially addictive treatments such as opioids.  ACA’s policy statement supports: investigating non-pharmacologic interventions for pain treatment; the promotion of evidence-based non-pharmacologic therapies within best practice models for pain management; improved access to providers of non-pharmacologic therapies; improved interprofessional education to augment the training of pain management teams; and public health campaigns to raise awareness of drug-free treatment options for pain syndromes. 

Now that a national emergency has been reported, President Trump noted that “federal drug prosecutions have gone down in recent years. We’re going to be bringing them up and bringing them up rapidly.”

The emergency declaration would give HHS broad authority.  

  • The agency could negotiate drug prices for medication-assisted treatments like buprenorphine to ensure providers maintained adequate supplies. That might help lower the cost of the overdose-reversal drug naloxone, which has risen steadily over the last few years. 

  • Current rules banning federal reimbursement for the cost of administering methadone at outpatient clinics could be waived.

  • The declaration of emergency would exempt providers from complying with certain requirements that often prevent them from getting paid. For example, HHS could temporarily lift Medicaid rules that limit how long patients can receive mental health or substance use disorder treatment in residential facilities with more than 16 beds. Currently the program covers the costs for up to 15 days.  Waiving that requirement would allow many, many more facilities to be able to accept patients, and maybe reduce waiting lists and get people the kind of help that they need when they need it.

  • In a state of emergency, the federal government could directly distribute naloxone and other medications directly to municipalities and states.

  • The declaration could also require hospital emergency rooms to provide treatment for covered patients with addictions instead of just holding those patients until they’re stabilized and then referring them to an addiction medicine specialist before they are discharged.

  • Other recommendations include setting requirements for physicians to take continuing medical education courses on opioid prescribing and tougher enforcement of mental health and substance abuse treatment parity laws, establishing a federal fund to expand greater access to medication-assisted treatment, and providing support to the National Institutes of Health for the development of new medication-assisted treatments and non-addictive pain management therapies.

Since 2014, Massachusetts, Virginia, Maryland, Alaska, Florida and Arizona have all made emergency declarations that temporarily allowed state health officials to launch statewide initiatives.

President Trump stated “you know when I was growing up they had LSD and they had certain generations of drugs. There's never been anything like what's happened to this country over the last four or five years. And I have to say this in all fairness, this is a worldwide problem, not just a United States problem. This is happening worldwide. But this is a national emergency and we are drawing documents now to so attest."

Sources:  http://www.modernhealthcare.com/article/20170810/NEWS/170819984