In a heartening display of bipartisan cooperation, the Senate on July 13 adopted the conference report on the Comprehensive Addiction and Recovery Act (CARA) of 2016(www.congress.gov) by an overwhelming margin. The chamber's 92-2 vote follows the House's decisive passage of the measure on July 8 and sends the sweeping legislation to President Obama, who is expected to sign the bill.
AAFP President Wanda Filer, M.D., M.P.H., of York, Pa., was quick to welcome the news. "The Comprehensive Addiction and Recovery Act will expand much-needed access to care for Americans struggling with substance abuse disorders -- a policy long-supported by the American Academy of Family Physicians and our members," she said in a statement issued July 14.
Provisions in the act address multiple components of the nation's opioid abuse and addiction crisis. Examples of the far-reaching actions it calls for include
- directing HHS, together with the Department of Veterans Affairs (VA), the Department of Defense and the Drug Enforcement Administration, to convene a task force composed of representatives from the public and private sectors -- including physicians -- to review, modify and update best practices for pain management and prescribing pain medications;
- On July 13, the Senate adopted the conference report on the Comprehensive Addiction and Recovery Act of 2016 by an overwhelming margin.
- The chamber's 92-2 vote follows the House's passage of the measure on July 8 and sends the sweeping legislation to President Obama, who is expected to sign the bill.
- AAFP President Wanda Filer, M.D., M.P.H., of York, Pa., welcomed the news, saying, "The Comprehensive Addiction and Recovery Act will expand much-needed access to care for Americans struggling with substance abuse disorders."
- bolstering health care professionals' use of opioid risk reporting tools and state prescription drug monitoring programs in VA facilities, as well as beefing up education and training on pain management and safe opioid prescribing practices for clinicians in those facilities, mandating the establishment of clinical teams to coordinate pain management therapy for patients with noncancer pain, and other measures;
- creating a pilot program to support family-based services for pregnant and postpartum women with a primary diagnosis of a substance use disorder, including opioid use disorders;
- studying the prevalence of neonatal abstinence syndrome (NAS), as well as the care settings in which infants with NAS are treated, best practices for treating infants born addicted to opioids, the reimbursement methodologies and costs associated with such treatment, and other related factors;
- authorizing multiyear funding for the Department of Justice to issue grants to states, local governments and Indian tribes to be used to develop or expand treatment alternatives to incarceration programs, train law enforcement officers and other first responders in the use of naloxone to reverse an opioid overdose, and for other purposes;
- authorizing HHS to establish grant programs to support co-prescribing opioid overdose reversal drugs for patients who are at increased risk for overdose, including those who are taking prescription opioids, and to develop standing orders for use of opioid overdose reversal drugs for pharmacies and encourage pharmacists to dispense the drugs pursuant to such orders;
- allowing partial filling of opioid prescriptions where not prohibited by state law; and
- modifying existing regulations to permit nurse practitioners and physician assistants to administer medication-assisted treatment for opioid use disorder in collaboration with or under the supervision of a qualifying physician (where state law requires such physician oversight).
Filer pointed to that last element as helping to advance a care model the Academy has long embraced.
White House Takes More Steps to Combat Opioid Crisis
- On July 6, the Obama administration announced(www.whitehouse.gov) new actions it is taking to "expand access to treatment, strengthen prescription drug monitoring, enable safe disposal of unneeded drugs, and accelerate research on pain and opioid misuse and overdose." Among those measures are the following:
- The Substance Abuse and Mental Health Services Administration has issued a final rule(www.federalregister.gov) increasing the number of patients for whom qualified physicians can prescribe buprenorphine to treat opioid use disorders from 100 to 275.
- The Indian Health Service will now require opioid prescribers and pharmacists in its system to check their state prescription drug monitoring program databases before prescribing or dispensing any opioid for more than seven days.
- HHS has released a request for information(www.federalregister.gov) seeking comments from clinicians, patients and other stakeholders on current HHS prescriber education and training programs and proposals for future activities.
- HHS is launching more than a dozen studies on opioid abuse and pain management to help fill knowledge gaps and bolster efforts to fight this epidemic.
- The Department of Agriculture issued nearly $1.4 million for five Distance Learning and Telemedicine grant awards(www.rd.usda.gov) to Kentucky, Tennessee and Virginia to help rural areas address the opioid epidemic.
- The Drug Enforcement Administration will hold its 12th National Prescription Drug Take-Back Day on Oct. 22 to promote responsible disposal of unneeded prescription drugs.
"CARA permits nurse practitioners and physician assistants to administer buprenorphine under the supervision of a physician who has authority to provide medication assisted treatment," she said. "In doing so, this legislation supports team-based care that improves patient safety while ensuring patients get the treatment they need."
Filer also lauded the fact that the act reauthorized the National All Schedules Prescription Electronic Reporting Act (NASPER), the only statutorily authorized program designed to assist states in combating abuse of controlled substances through a prescription drug monitoring program.
Enacted in 2005 and administered by HHS, NASPER fosters interstate communication by providing grants to establish or improve state systems that meet basic standards of information collection and privacy protections that allow states to more easily share information, thus enabling authorities to identify prescription drug abusers.
"Family physicians understand that there are patients with inappropriate drug-seeking behavior," said Filer. "However, it can be difficult to quickly identify these individuals without a database containing this information. Family physicians in states with prescription drug monitoring programs find such databases useful tools in treating patients and in preventing diversion."
Filer also called for more funding for NASPER, which she said would "help stem the growing problem of interstate diversion and misuse of narcotics by allowing family physicians to determine whether a patient has received prescriptions in other states and locations."
But, she cautioned, such prescription drug monitoring programs must be seamless and interoperable across state lines. "They must provide real-time information and they must minimize time taken away from patient care by fitting into physicians' workflow patterns," Filer said.
Lamenting the devastating toll opioid abuse and addiction have taken on individual patients, their families and communities, Filer applauded the legislation for offering family physicians the ability to identify patients struggling with substance abuse and ensuring that they can receive treatment that is both safe and accessible.
"These provisions will move our national effort to end prescription drug abuse and the ruinous impact it has on individual lives, on families and on our communities," Filer concluded.
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