White House, HHS Expand Fight Against Opioid, Heroin Abuse

April 06, 2016 09:23 am Chris Crawford

While attending the National Rx Drug Abuse and Heroin Summit in Atlanta on March 29, President Obama announced additional public and private sector actions to escalate the fight against the prescription opioid abuse and heroin epidemic.

[Pills lined up on pink background]

According to a White House fact sheet,(www.whitehouse.gov) these actions will build on the president's proposed $1.1 billion in new funding to support this effort.

HHS Initiatives

HHS will issue a proposed rule to increase the current patient limit for physicians who prescribe buprenorphine to treat opioid use disorders from 100 to 200 patients.

According to the fact sheet, the proposed rule is intended to expand access for tens of thousands of patients to this evidence-based treatment while preventing diversion.

Robert Rich, M.D., past chair of the AAFP Commission on Health of the Public and Science and the AAFP's representative on the AMA Task Force to Reduce Opioid Abuse, told AAFP News that it's good news that physicians will have an increased number of patients they can treat with buprenorphine but he's not sure if this move might end up being impeded by state laws.

Story highlights
  • On March 29, President Obama announced additional public and private sector actions to escalate the fight against the prescription opioid abuse and heroin epidemic.
  • HHS will issue a proposed rule to increase the current patient limit for physicians who prescribe buprenorphine to treat opioid use disorders from 100 to 200 patients.
  • HHS also is finalizing a rule to require that mental health and substance use services offered through Medicaid and the Children's Health Insurance Program be offered at parity.

"The reason I say that is sometimes state regulations can add to the complexity of buprenorphine prescribing and still make it difficult for primary care physicians to prescribe the drug on a consistent basis," he said.

HHS also released $94 million in new funding to 271 community health centers across the United States in March to increase substance use disorder treatment services while focusing on expanding medication-assisted treatment of opioid use disorders in underserved communities. HHS estimates this effort could help the health centers treat nearly 124,000 new patients with substance disorders.

Rich said this increased funding would be particularly helpful in rural and metropolitan areas that are underserved. But he added that there also are plenty of independent primary care physicians who could use additional funds to treat opioid use disorders.

Mental Health and Substance Use Disorder Parity

The White House has directed the creation of an interagency Mental Health and Substance Use Disorder Parity Task Force that will be chaired by the Domestic Policy Council.

HHS also is finalizing a rule to require that mental health and substance use services offered through Medicaid and the Children's Health Insurance Program (CHIP) be offered at parity -- meaning they must be comparable in coverage to medical and surgical benefits. This effort is projected to benefit more than 23 million patients enrolled in Medicaid and CHIP.

"There certainly is some inequity in the amount of coverage for mental health and substance abuse treatment," Rich said. "Calling for parity in that coverage and reimbursement clearly is a step in the right direction to increase the availability to those treatments."

SAMHSA Funding

It also was announced that the Substance Abuse and Mental Health Services Administration (SAMHSA) will release $11 million for up to 11 states to expand their medication-assisted treatment services.

In addition, SAMHSA will distribute 10,000 pocket guides for physicians that include a checklist for prescribing medication for opioid use disorder treatment and integrating non-pharmacologic therapies, as well.

Rich said he'd like to see more funding considering the effort spans 11 states, but he added that the pocket guides, checklists and other tools could be very helpful.

Additional Actions

On top of the initiatives mentioned above, the government has a couple other ideas in the works.

First, the Office of National Drug Control Policy will expand its heroin initiative among regional High Intensity Drug Trafficking Areas (HIDTAs) by adding Ohio and Michigan to the effort.

These states will join the Appalachia, New England, Philadelphia/Camden, New York/New Jersey and Washington/Baltimore HIDTAs in accelerating local partnerships between law enforcement and their counterparts in public health to combat heroin use and overdose, according to the White House fact sheet.

"Anything you do to support the partnerships between agencies is always beneficial," Rich said. For example, he pointed to his home state of North Carolina's successful Project Lazarus,(www.projectlazarus.org) which uses partnerships among medical professionals, hospital officials, law enforcement agents, members of the faith community, and social services and education representatives to reduce overdose deaths in rural Wilkes County "down to basically zero."

The North Carolina Medicaid program, administered by the nonprofit Community Care of North Carolina, subsequently adopted the project and, since 2012, has been in the process of rolling Project Lazarus out to all of the counties in North Carolina.

Finally, last week, the Department of Agriculture announced it would expand its $1.4 million Rural Health and Safety Education Grant Program to include a focus on addressing the challenges related to substance use disorders in rural communities across the country.

Overall, Rich said the president's announcement of these initiatives will further bolster the government's effort to help fight this epidemic.

"The president is once again drawing attention to the problem (of opioid and heroin abuse) and trying to make some executive actions to the best of his ability to combat this problem," Rich said. "We need all of these actions to be successful."

Related AAFP News Coverage
HHS Releases Final Version of National Pain Strategy
FDA Issues Draft Guidance on Abuse-deterrent Opioids, Adds Safety Warnings to Packaging

(3/30/2016)

CDC Releases Final Guideline for Prescribing Opioids for Chronic Pain
More Research Still Needed to Support the Guidance

(3/16/2016)

Senate Bill to Reduce Opioid Abuse Draws Bipartisan Support
AAFP Commends Goals but Issues Caution on Some Elements of Legislation

(3/9/2016)


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