Trump’s opi­oid epi­demic com­mis­sion wants the pres­i­dent to de­clare a state of emer­gency

South Florida Times - - HEALTH - By Trump’s opi­oid epi­demic com­mis­sion is headed by Chris Christie, Governor of New Jersey.


A com­mis­sion cre­ated by Pres­i­dent Don­ald Trump has asked him to de­clare a state of emer­gency over the na­tion’s opi­oid epi­demic.

The rec­om­men­da­tion, from a pre­lim­i­nary draft of the opi­oid com­mis­sion’s re­port, comes in the midst of gru­el­ing statis­tics linked to the epi­demic. In 2016 alone, drug over­doses likely killed more Amer­i­cans in one year than the en­tire Viet­nam War. In 2015, drug over­doses topped an­nual deaths from car crashes, gun vi­o­lence, and even HIV/AIDS dur­ing that epi­demic’s peak in 1995.

“With ap­prox­i­mately 142 Amer­i­cans dy­ing ev­ery day, Amer­ica is en­dur­ing a death toll equal to Septem­ber 11th ev­ery three weeks,” the re­port ar­gues. “Af­ter Septem­ber 11th, our Pres­i­dent and our na­tion banded to­gether to use ev­ery tool at our dis­posal to pre­vent any fur­ther Amer­i­can deaths. Your dec­la­ra­tion would em­power your cab­i­net to take bold steps and would force Congress to fo­cus on fund­ing and em­pow­er­ing the Ex­ec­u­tive Branch even fur­ther to deal with this loss of life.”

The com­mis­sion, which is chaired by New Jersey Gov. Chris Christie (R), Mas­sachusetts Gov. Char­lie Baker (R), North Carolina Gov. Roy Cooper (D), for­mer Rep. Pa­trick Kennedy (D), and Dr. Bertha Madras, also makes sev­eral other rec­om­men­da­tions. Here are some of the big ones:

• Grant waiver ap­provals for all 50 states to elim­i­nate ex­ist­ing reg­u­la­tory bar­ri­ers in the Med­i­caid pro­gram that ex­clude the fed­eral In­sti­tutes for Men­tal Dis­eases. Un­der the So­cial Se­cu­rity Act, fed­eral Med­i­caid funds can’t re­im­burse ser­vices from in­pa­tient fa­cil­i­ties that treat “men­tal dis­eases,” in­clud­ing addiction, with more than 16 beds. Elim­i­nat­ing this bar­rier would let states “im­me­di­ately open treat­ment to thou­sands of Amer­i­cans in ex­ist­ing fa­cil­i­ties in all 50 states,” ac­cord­ing to the com­mis­sion.

• Im­me­di­ately set up and fund a fed­eral pro­gram to im­prove ac­cess to med­i­ca­tionas­sisted treat­ment. This is the gold stan­dard of opi­oid addiction treat­ment, with re­search show­ing that it can re­duce the all-cause mor­tal­ity rate among addiction pa­tients by half or more. But it re­mains in­ac­ces­si­ble; only 10 per­cent of con­ven­tional drug treat­ment fa­cil­i­ties in the US pro­vide med­i­ca­tion-as­sisted treat­ment for opi­oid use dis­or­der, ac­cord­ing to the com- mis­sion. The re­port wants this treat­ment greatly ex­panded, from health care set­tings in prison to tra­di­tional drug treat­ment fa­cil­i­ties.

• Bet­ter en­force fed­eral law that re­quires health in­sur­ers to pro­vide equal ac­cess to men­tal health ser­vices, in­clud­ing addiction. Health in­sur­ers of­ten cre­ate oner­ous bar­ri­ers to men­tal health care, see­ing it as ex­pen­sive. Fed­eral law tech­ni­cally out­laws this for the plans that cover be­hav­ioral health, but the law re­mains poorly en­forced. The re­port rec­om­mends that the fed­eral govern­ment, par­tic­u­larly the sec­re­tary of la­bor, bet­ter en­force the law.

• Ex­pand ac­cess to the opi­oid over­dose an­ti­dote nalox­one. Among other plans, the com­mis­sion vows to pro­vide model leg­is­la­tion so states can al­low the dis­pens­ing of nalox­one through a stand­ing or­der. Bal­ti­more Health Com­mis­sioner Leana Wen used such leg­is­la­tion in 2015 to let any­one in the city carry nalox­one; she es­ti­mates that it’s saved more than 950 peo­ple from over­dose over the past two years.

• Man­date ed­u­ca­tion ini­tia­tives, with the help of med­i­cal schools and by amend­ing the Con­trolled Sub­stances Act, to re­quire bet­ter train­ing for pre­scribers about the treat­ment of pain and addiction. The opi­oid epi­demic be­gan when doc­tors pre­scribed an enor­mous amount of opi­oid painkillers, caus­ing the drugs to pro­lif­er­ate across the coun­try. By get­ting doc­tors to pre­scribe opi­oids more re­spon­si­bly, the com­mis­sion aims to pull back the orig­i­nal source of the cur­rent drug over­dose crisis.

• Pro­vide fed­eral sup­port for state-based pre­scrip­tion drug mon­i­tor­ing pro­grams.These pro­grams, which all 50 states now have, let doc­tors closely watch a pa­tient’s pre­scrip­tion drug his­tory — let­ting them see if, say, a pa­tient is shop­ping around to ob­tain as many opi­oids as pos­si­ble from dif­fer­ent doc­tors, or if a pa­tient has a his­tory of mis­us­ing drugs. But these pro­grams of­ten aren’t very ro­bust and don’t share data across state lines, which fed­eral aid could help ad­dress.

• Fund more re­search for non-opi­oid painkillers. The cur­rent drug crisis be­gan in part as doc­tors sought to tackle an­other ma­jor med­i­cal prob­lem: 100 mil­lion US adults suf­fer from chronic pain. De­spite the lack of ev­i­dence for opi­oids’ ef­fec­tive­ness in treat­ing chronic pain, doc­tors of­ten re­sponded with opi­oids. By find­ing non­ad­dic­tive, ef­fec­tive painkillers, the com­mis­sion wants to give doc­tors a bet­ter, safer op­tion. • Step up ef­forts to in­ter­dict fen­tanyl. As the opi­oid epi­demic has pro­gressed, many peo­ple suf­fer­ing from opi­oid drug use dis­or­der have moved from painkillers to heroin. More re­cently, though, much of this heroin has been laced with the even more po­tent opi­oid fen­tanyl — of­ten without the knowl­edge of the peo­ple buy­ing the heroin. This fen­tanyl is syn­thet­i­cally man­u­fac­tured, and it of­ten comes from around the world, such as clan­des­tine labs in China. Among other pro­pos­als, the re­port asks for greater sup­port for law en­force­ment and US Postal Ser­vice ef­forts — through more man­power and bet­ter tech- nol­ogy, for ex­am­ple — to catch fen­tanyl as it’s trans­ported.

The com­mis­sion’s re­port ad­dresses both sides of the opi­oid crisis: what Stan­ford drug pol­icy ex­pert Keith Humphreys has de­scribed to me as the “stock” and the “flow.” On one hand, you have the cur­rent stock of opi­oid users who are ad­dicted; the peo­ple in this pop­u­la­tion need treat­ment or they will sim­ply find other, po­ten­tially dead­lier opi­oids to use if they lose ac­cess to painkillers. On the other hand, you have to stop new gen­er­a­tions of po­ten­tial drug users from ac­cess­ing and mis­us­ing opi­oids.


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