Insurers Declare Addiction Deserves the Same Urgency and Respect as Cancer

Source: | November 13th, 2017
The nation’s largest insurers issued a statement last week that addiction deserves the same urgency and respect as cancer or diabetes, and should be treated as a chronic disease requiring long-term treatment and monitoring.  16 health insurers covering 248 million people adopted 8 principles of care and said they would use their purchasing power to reward proven, evidence-based treatments, a step that could improve the quality of care available.   UnitedHealth Group, Aetna, Cigna and WellCare, all national companies were among the endorsing companies.  The eight core principles the insurers supported were derived from the U.S. Surgeon General’s 2016 report on alcohol, drugs and health.  These core principles are also providing the foundation for the work being done by Shatterproof’s Substance Use Disorder Treatment Task Force to create a universal standard of care for addiction.
 Source:  USA Today
  1. Routine screenings in every medical setting: During check-ups and in the ER, from pediatric to geriatric care-screenings for an SUD should be as common as measuring blood pressure.
  2. A personal plan for every patient: One size doesn’t fit all. Treatment must consider unique social, mental, biological, and environmental needs-with frequent check-ins and adjustments.
  3. Fast access to treatment: Addiction alters brain chemistry. So when an individual is able to seek treatment, that moment must be seized.
  4. Disease management, rather than 28 days: While inpatient treatment may be appropriate for some based on disease severity, this isn’t the best option for all. And it’s not enough for sustained success. Long-term outpatient care is key to recovery.
  5. Coordinated care for every illness: Many people with addiction also suffer from other mental or physical disorders. Treatment for all illnesses should be coordinated and integrated into the SUD treatment plan.
  6. Behavioral health care from legitimate providers: Behavioral interventions help individuals manage their disease and sustain recovery – and should be offered by properly trained, accredited, and well-supervised providers.
  7. Medication-assisted treatment: Just like with any other chronic disease, medication is appropriate for treating some addictions. It should be destigmatized and easily accessible.
  8. Support for recovery outside the doctor’s office: Recovery requires emotional and practical support from family members, the community, and peer groups.

President Trump’s Opioid Commission Issues Report

Source: | November 3rd, 2017
The final draft of the report includes over 50 recommendations on a variety of federal, state, and local agencies, but it stops short of calling for new federal dollars. Below are some of the biggest recommendations in the report. For all 56 proposals, read the full report.
  • Streamline federal funding for drug addiction using “one application and one set of reporting requirements.” The commission argues this would let states focus less on paperwork and more on actually implementing policies.
  • Remove barriers to treatment including better enforcement of parity laws that in theory require insurers to pay for such care.
  • Develop “a national curriculum and standard of care for opioid prescribers.” It also proposes that the Drug Enforcement Administration (DEA) require doctors renewing their opioid prescribing licenses to attend an education program for such prescriptions.
  • Stop evaluating doctors based on pain scores. The commission asks that patient satisfaction surveys used to evaluate doctors no longer include any questions about pain.
  • Allow more emergency responders to deploy naloxone and include all medical staff in the National Highway Traffic Safety Administration best-practices guide for emergency responders.
  • Tougher prison sentences for the trafficking of fentanyl and fentanyl analogues.
  • A media campaign on addiction stigma and the dangers of opioids.

House Select Committee on Opioids and Substance Use

Source: | October 27th, 2017

Speaker Straus created a Select Committee on Opioids and Substance Abuse which was included in his Interim Committee Charges. This Select committee will study the prevalence and impact of substance abuse and substance use disorders in the state. “Two years ago, we formed the Committee on Mental Health to look at behavioral health and substance abuse issues, and this new committee will continue some of that work,” Speaker Straus said. Rep. Four Price (Amarillo) has been tapped by the Speaker to chair and Rep. Joe Moody (El Paso) will serve as Vice Chairman. “Addressing the growing problems of substance abuse and opioid addictions would have a positive impact across the state by reducing the burden on the health care and criminal justice systems, Price said. “It’s an issue that Texans everywhere are dealing with”. ASAP worked well with Chairman Price and his office over the past biennium on the Behavioral Health Select Committee and legislation that was introduced from the committee’s findings. For his outstanding leadership directing that committee and passing significant legislation, particularly HB 10 to enforce parity, ASAP was honored to select him as a 2017 Lone Star Award recipient. We are excited to work with him again and look forward to similar positive results from the committee’s work.  he committee members are:

 

Representatives
 
Carol Avarado  (Houston)
Garnet Coleman (Houston)
Jay Dean (Longview)
Ina Minjarez (San Antonio)
Andy Murr (Junction)
Poncho Nevarez (Eagle Pass)
Kevin Roberts (Houston)
Toni Rose (Dallas)
J.D. Sheffield (Gatesville)
Gary VanDeaver (New Boston)
James White (Hillister)

Former CDC Director Recommends 10 Actions to Reduce Opioid Epidemic

Source: | October 17th, 2017
Tom Frieden, MD, MPH and his colleague published an article in Journal of the American Medical Association about actions that could be taken at the federal and state level to accelerate progress in preventing addiction, overdose and death. Below are the 10 specific areas:

 

Source:  The Hill
  1. Improve tracking of new opioid addiction-
  2. Improve quality of medical examiner and coroner work.
  3. Promote more cautious prescribing for acute pain.
  4. Restrict or eliminate marketing of opioids for chronic pain
  5. Increase insurance coverage for non-opioid pain management-
  6. Interrupt the supply of illicit opioids-
  7. Identify possible opioid addiction early-
  8. Expand access to treatment
  9. Implement harm reduction for current users
  10. Consider removing ultra-high dosage opioids from the market

NIAAA Alcohol Treatment Navigator

Source: | October 6th, 2017
A new online resource is now available to help people recognize and find high quality care for alcohol use disorder. The Alcohol Treatment Navigator, designed by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) is a comprehensive, yet easy-to-use tool to help individuals and their loved ones navigate the often-complicated process of choosing treatment for alcohol problems. With many treatment options available, the navigator makes the search easier by telling them what they need to know – and what they need to do – to find appropriate, quality care. “We developed this tool to help address the alcohol ‘treatment gap,’” said NIAAA Director George F. Koob, Ph.D. “In any given year, less than 10 percent of individuals diagnosed with alcohol use disorder receive treatment, and many of them do not receive the type of care that best fits their needs.” Overall, the Alcohol Treatment Navigator is an easy-to-use and comprehensive resource that can inform the search for quality treatment.  It includes:
  • An overview of alcohol use disorder
  • A description of different kinds of professionally-led treatment options
  • Step-by-step instructions for searching several existing online directories of treatment providers, including information from the Substance Abuse and Mental Health Services Behavioral Health Treatment Locator
  • Ten questions to ask a provider, and 5 signs of quality to listen for
  • A downloadable Toolkit to help organize and simplify the search process

Alcohol Abuse Rising Among Older Adults

Source: | September 29th, 2017
Epidemiologists at the National Institute on Alcohol Abuse and Alcoholism reported a jarring trend: Problem drinking is rising fast among older Americans. Their study, published in JAMA Psychiatry, compared data from a national survey taken in 2001 and 2002 and again in 2012 and 2013, each time with about 40,000 adults. Drinking had increased in every age group , but there was a 65% jump in the proportion of older adults engaged in high-risk drinking and alcohol use disorders  more than doubled in a decade, afflicting over 3 percent of older people. Even if the rate of alcohol problems among older people doesn’t climb further, the sheer numbers will increase. “The growth in that population portends problems down the road,” said Bridget Grant, an epidemiologist at N.I.A.A.A. and the lead author of the study. Even for healthy older adults, they’re still prone to late-life physical changes that make drinking riskier including negative interactions with hundreds of medications. While two drinks a night at age 40 might not be an issue, two daily drinks at 70 is more complicated. We may already be seeing the health consequences, Dr. Grant pointed out. The nation’s sharp decline in cardiovascular disease and strokes has begun to level off and Emergency room visits for alcohol-related falls, particularly disabling for seniors, have increased. So have deaths from liver cirrhosis. “It’s the first time we’ve seen those rates go up since the 1960s,” Dr. Grant said. “It’s shocking.”

 

Source:  New York Times

President Trump’s Opioid Emergency Not Official

Source: | September 1st, 2017
On August 10, President Trump announced that the opioid crisis was a national emergency, which was the priority recommendation in the preliminary report submitted by his Commission on Combating Drug Addiction and the Opioid Crisis issued in July.  However, the president hasn’t yet signed a formal declaration and sent it to Congress. “Relevant monies won’t be released until such a thing is signed,” said Northwestern University law professor Eugene Kontorovich. A White House spokesperson did not say when a signature could be expected. “The president recently instructed his administration to take all appropriate measures to confront the opioid crisis,” the spokesperson said. “Right now, these actions are undergoing an expedited legal review. In response to the delay, Senators Durbin (IL), Brown(OH), Manchin (WV), Booker (NJ),  King (ME), Portman (OH),  Capito (WV), and  Collins (ME) urged President Trump to lift the Medicaid Institutions for Mental Disease (IMD) Exclusion for residential substance use disorder treatment as part of his opioid emergency declaration. In May, the senators introduced the bipartisan Medicaid Coverage for Addiction Recovery Expansion (Medicaid CARE) Act, which would modify the IMD Exclusion – a policy created in 1965 that limits Medicaid coverage for substance abuse treatment to facilities with less than 16 beds. The Medicaid CARE Act would expand it to 40 treatment beds. Additionally, the Medicaid CARE Act establishes a new $50 million youth inpatient addiction treatment grant program to fund facilities that provide services to underserved, at-risk Medicaid beneficiaries’ younger than 21, with an emphasis on rural communities. The bill would also increase flexibility for pregnant and postpartum women who are seeking treatment.

Impact of Dropping Out of School

Source: | August 25th, 2017
A new SAMHSA report reveals that substance use was more likely among 12th grade aged dropouts than among 16 to 18 year olds who were still in school. “The impact of dropping out of high school is profound” said Frances M. Harding, Director for SAMHSA’s Center for Substance Abuse Prevention. “Substance abuse prevention efforts can reduce the risk of individuals dropping out of school which greatly increases their likelihood of future positive employment, financial and health outcomes.”  Several SAMHSA and NIDA resources are available:

Source: SAMHSA

Online guides and tip sheets for youths that address the risks of initiating use across a wide variety of substances, including:

Trump Declares the Opioid Crisis a National Emergency

Source: | August 11th, 2017
“The opioid crisis is an emergency, and I’m saying officially right now,” Trump said. “We’re going to spend a lot of time, a lot of effort and a lot of money on the opioid crisis.” Trump, speaking after a security briefing at his golf club in Bedminster, N.J. on Thursday, said his administration is preparing the paperwork for the declaration. Doing so was the most urgent recommendation coming from President’s Commission on Combating Drug Addiction and the Opioid Crisis interim recommendations. This executive action would make the epidemic a top priority and allow the Cabinet to take “bold steps” toward combating drug abuse according to the Commission’s letter. Declaring a national emergency removes some barriers and places urgency behind waiving some federal rules such as the IMD Exclusion rule which prohibits the use of federal funds for Medicaid patients in residential mental health or substance-use disorder treatment centers with more than 16 beds. It would also put pressure on Congress to provide more funding and enhance the administration’s ability to make grants and conduct investigations.
Source:  Fox News

President’s Commission on Combating Drug Addiction & the Opioid Crisis

Source: | August 5th, 2017
The President’s Commission on Combating Drug Addiction and the Opioid Crisis has issued its interim recommendations.  The first and most urgent recommendation is for the President to declare a national emergency under either the Public Health Service Act or the Stafford Act. The Report states, “With approximately 142 Americans dying every day, America is enduring a death toll equal to September 11th every three weeks. 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.”
  • Grant waiver approvals for all 50 states to quickly eliminate barriers to treatment resulting from the federal Institutes for Mental Diseases (IMD) exclusion within the Medicaid program.
  • Mandate medical education training in opioid prescribing and risks of developing an SUD by amending the Controlled Substance Act to require all Drug Enforcement Administration (DEA) registrants to take a course in proper treatment of pain
  • Immediately establish and fund a federal incentive to enhance access to Medication Assisted Treatment (MAT). Require that all modes of MAT are offered at every licensed MAT facility.
  • Provide model legislation for states to allow naloxone dispensing via standing orders and require the prescribing naloxone with high-risk opioid prescriptions; equip all law enforcement in the United States with naloxone to save lives.
  • Prioritize funding and manpower to the Department of Homeland Security’s (DHS) Customs and Border Protection, the DOJ Federal Bureau of Investigation (FBI), and the DEA to quickly develop fentanyl detection sensors and support federal legislation to staunch the flow of deadly synthetic opioids through the U.S. Postal Service (USPS).
  • Provide federal funding and technical support to states to enhance interstate data sharing among state-based prescription drug monitoring programs (PDMPs).
  • Align patient privacy laws specific to addiction with the Health Insurance Portability and Accountability Act (HIPAA) to ensure that information about SUDs be made available to medical professionals treating and prescribing medication.
  • Enforce the Mental Health Parity and Addiction Equity Act (MHPAEA) with a standardized parity compliance tool to ensure health plans cannot impose less favorable benefits for mental health and substance use diagnoses verses physical health diagnoses.
The final report, due in October, will include a full-scale review of federal programs, regulations, laws, and funding mechanisms targeted toward addressing addiction and a more thorough examination of the following issues:
  • Development of a national prevention strategy using “big data analytics” to devise targeted prevention messages that employ cutting-edge methods of marketing and communications.
  • Evidence-based prevention programs for schools, and tools for teachers and parents to enhance youth knowledge of the dangers of drug use, as well as early intervention strategies for children with environmental and individual risk factors (trauma, foster care, adverse childhood experiences (ACEs), and developmental disorders).
  • The need for satisfaction with pain level as a satisfaction criterion through which health care providers are evaluated by HHS.
  • Workforce access and training needs within the treatment community nationally, with a focus on the regions of the country with the highest overdose deaths.
  • Improvements in treatments programs, based on adherence to principles of evidence based treatment, continuum of care, outcome measures, and patient education on quality treatment.
  • Research initiatives and opportunities to combat the epidemic and enhance treatment options, including alternative pain management strategies, and treatment for vulnerable populations such as pregnant women, and substance-exposed infants.
  • Opportunities to further the practice of substance use screenings and referrals through CMS quality measures.
  • Opportunities for patient protections providing better information about the risks and benefits of taking prescription opioids.
  • Supply reduction of heroin, fentanyl analogs and counterfeit pills through coordinated federal and state law enforcement initiatives.
  • Targeted data collection and analytics needed to identify most effective prevention and treatment strategies, quality treatment access programs, reimbursements, and aid to law enforcement activities. The possibility of a behavioral health surveillance system run through CDC that tracks prevalence rates, treatment modalities, and comorbidities with other illnesses in real-time.
  • Regulatory or statutory changes to reduce commercial insurance barriers to MAT, such as dangerous fail-first protocols and onerous and frequent prior authorization requirements.