What declaring a national emergency on opioids could mean for healthcare

The White House commission set up by President Donald Trump to address the nation’s opioid addiction epidemic has recommended declaring a national public health emergency, which would impact healthcare providers.

The five-member commission, headed by New Jersey Gov. Chris Christie, issued its interim report on July 31, about four month after Trump created the group by executive order. It puts much of the blame for the epidemic on the healthcare industry, citing how the number of opioid overdoses and prescriptions have both quadrupled since 1999.

“In other words, Mr. President, this crisis began in our nation’s healthcare system,” the report said. “While we acknowledge that some of this inappropriate overprescribing is done illegally and for profit, we believe the overwhelming percentage is due to a lack of education on these issues in our nation’s medical and dental schools and a dearth of continuing medical education for practicing clinicians. This can and must be solved by using presidential moral and legal authority to change this lack of education leading to addiction and death.”

With 142 people dying from drug overdoses every day, the commission said declaring a national emergency would allow agencies under the executive branch to take action more quckly to address the crisis. For example, the report said after an emergency declaration, HHS Secretary Tom Price, MD, could immediately grant waivers to states to allow Medicaid reimbursement for inpatient facilities treating “mental diseases,” including addiction, which have more than 16 beds.

The commission’s other recommendations included:

• Mandate medical education training on opioid prescriptions by requiring all registered Drug Enforcement Agency (DEA)-registered prescribers to take a course in the proper treatment of pain. It was also recommended HHS agencies review and recommend training standards with the Accreditation Council for Continuing Medical Education (ACCME).
• More funding for medication-assisted treatment (MAT). Easier access to this proven treatment, the report said, will require getting state Medicaid to cover MAT drugs which have been approved by the U.S. Food and Drug Administration, as well as all federally-qualified health centers to get staff waivers to prescribe buprenorphine.
• Have HHS negotiate reduced pricing for naxalone, which can reverse the effects of opioid overdose, and have the Centers for Disease Control and Prevention require naxalone be included with any high-risk opioid prescription.
• Require all state-run prescription drug monitoring programs (PDMPs) share information between states and with the federal government, and increase their use among opioid prescribers.
• Change addiction-specific provisions of the Health Insurance Portability and Accountability Act (HIPAA) to allow providers easier access to patient information about substance abuse disorders.

The commission’s full report will include further recommendations after more federal programs are reviewed. One area it mentioned targeting was patient satisfaction scores and whether pain level should be included in those evaluations. The fear of lower Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores has been used to argue physicians are incentivized to prescribe more opioids, but a recent study in JAMA found no such link between them.