Presidential Commission on Combating Drug Addiction and the Opioid Crisis

August 10th, 2017 by Trudy Henson

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By CHHS Public Health Director Trudy Henson and RA Bach Nguyen 

As both opioid addiction rates and opioid related deaths nationwide continue to increase exponentially, legislators and government officials have taken action both at the state and federal level. Among these efforts is the President’s Commission on Combating Drug Addiction and the Opioid Crisis, established by executive order in late March of this year. The Commission, led by Gov. Chris Christie of New Jersey, was created to study the impact of the federal response to the issue and make recommendations to improve the federal response, and it issued a preliminary report on July 31st. In the report, the Commission, among other things, urged the President to “declare a national emergency under either the Public Health Service Act or the Stafford Act.” This follows trends set by several state governments, where “[g]overnors in Florida, Arizona, and Maryland have previously declared states of emergency, granting those governments access to millions of dollars and, in some cases, regulatory leeway in administering their responses.

Other Commission recommendations include:

  • A rapid increase in treatment capacity by expanding Medicaid coverage to include federal Institutes for Mental Diseases.
  • Mandating prescriber education and training regarding opioid prescription and risk.
  • Establishing and funding a federal incentive program for Medication-Assisted Treatment, including a partnership with NIH to develop new treatment options.
  • Creating model legislation for states to issue standing orders for dispensing Naloxone, as well as equipping law enforcement with the overdose-reversing drug.
  • Increasing funding and support to security agencies to develop fentanyl sensors to stem the trafficking of the drug.
  • Providing funding and technical support to increase interstate data sharing across prescription drug monitoring programs (PDMPs).
  • Modifying patient privacy laws to ensure that substance-use disorder information is available to treating medical professionals.
  • Enforcing the Mental Health Parity and Addiction Equity Act (MHPAEA) to ensure that health plans treat substance-use disorder the same as other health disorders.

It’s worth noting that many states have already implemented similar laws and policies as those shown above, such as Maryland’s standing order for Naloxone dispensing earlier in the Summer. (Maryland has remained at the forefront in the fight against opioids, being one of the first states to declare a state of emergency, and establishing the Maryland Opioid Operational Command Center.) Other states have taken numerous, and comprehensive, legislative responses to the crisis.

The Commission’s report has met a mixed response, with some legislators expressing doubt about the recommendations being able to impact the crisis quickly. Others in the public health community, such as Baltimore City Health Commissioner Dr. Leana Wen, supported the recommendations but urged the Commission to go further, suggesting that the Commission include:

  • Focusing on destigmatization of addiction through initiatives like Baltimore’s Don’t Die campaign;
  • Expanding health insurance by measures such as protecting Medicaid and ensuring that addiction and mental health treatment is an essential health benefit in every health plan;
  • Highlighting and encouraging innovative state and local efforts to combat the opioid epidemic;
  • Requiring physicians integrate substance use disorder treatment in their medical practices; and
  • Giving concrete numbers regarding funding to be allocated to combating this crisis.

Above all else, Dr. Wen emphasizes the need for federal resources and funding to combat the epidemic.

Lawmakers’ concerns about the Commission’s speedy response is a point well-taken: although state and federal lawmakers have taken laudable steps to respond to the crisis, a recent report found that opioid overdose rates continued higher in 2016. To date, President Trump has not declared a state of emergency, emphasizing instead the need to prevent drug abuse. Whether the Commission’s other recommendations will be heeded remains to be seen. The Commission is expected to release a final report in October.

(Photo: Evan Vucci/AP)

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