Obama Administration Takes More Actions to Address the Prescription Opioid and Heroin Epidemic

Action from Congress urgently needed to provide resources for treatment

As Congress moves to conference on legislation related to the prescription opioid and heroin epidemic, the Obama Administration is taking additional actions 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.

The President has made clear that addressing this epidemic is a priority for his Administration.  While Federal agencies have been using their authority to take every available action they can, Congress needs to take action on what is most urgently needed now – additional funding to make lifesaving treatment available to everyone who seeks it. The President has called for $1.1 billion in new funding to help Americans who want treatment get it wherever they live. These maps show how much new funding for treatment each State could potentially qualify for if Congress passes what the President has requested. 

Every day that passes without Congressional action to provide these additional resources is a missed opportunity to get treatment to those who want it, help prevent overdoses and support communities across the country impacted by this epidemic. Recovery from opioid and other substance use disorders is possible, and many Americans are able to recover because they get the treatment and care they need. But too many still are not able to get treatment. That’s why the President has called on Congress to provide the resources needed to ensure that every American with an opioid use disorder who wants treatment can get it and start the road to recovery.

Expanding Access to Treatment:  

The Department of Health and Human Services (HHS), through the Substance Abuse and Mental Health Services Administration, is issuing a final rule to increase from 100 to 275 the number of patients that qualified physicians who prescribe buprenorphine for opioid use disorders can treat. Providers, policymakers, advocates, and experts have pointed to the current 100 patient limit for buprenorphine prescribing as a barrier to opioid use disorder treatment. The rule aims to increase access to medication-assisted treatment and associated behavioral health supports for tens of thousands of people with opioid use disorders, while preventing diversion.

Improving Prescription Drug Monitoring by Federal Prescribers:

• Indian Health Service: While many Indian Health Service (IHS) clinicians already utilize Prescription Drug Monitoring Programs (PDMPs), IHS will now require its opioid prescribers and pharmacists to check their State PDMP databases prior to prescribing or dispensing any opioid for more than seven days.  The new policy is effective immediately for more than 1,200 IHS clinicians working in IHS federally operated facilities who are authorized to prescribe opioids. Checking a PDMP before prescribing helps to improve appropriate pain management care, identify patients who may have an opioid use disorder and prevent diversion of drugs. This policy builds on other IHS efforts to address the opioid epidemic. In December, IHS announced that it would provide hundreds of Bureau of Indian Affairs law enforcement officers with the lifesaving opioid overdose-reversal drug naloxone and train them how to use it.
   
• Department of Veterans Affairs: As part of its efforts to prevent and treat opioid use disorder among Veterans, VA is releasing a new policy for its health care providers who prescribe controlled substances that requires them (or where allowed their delegate) in most cases to check State PDMPs prior to deciding to prescribe a new controlled substance to determine if a patient is receiving opioids or other controlled substances from another provider and document that in the electronic patient record. These checks will occur at a minimum once a year and/or when clinically indicated for each renewal or continuation of therapy. VA provides health care services to approximately 8.3 million veterans at 150 medical centers, nearly 1,400 community-based outpatient clinics, community living centers, Vet Centers and Domiciliaries.
   
• Department of Defense: By the end of November 2016, DOD will have conducted an evaluation of its prescription drug monitoring program to assess its ability to capture community providers and use of cash transitions; identify any gaps in comprehensive use of prescription drug monitoring strategies; and make recommendations for closing those gaps.

Advancing Prescriber Education:  

One of the ways HHS is working to stem the overprescribing of opioids is by providing prescribers with access to the tools and education they need to make informed decisions. Today HHS is releasing a Request for Information that seeks provider, consumer and other public comments on current HHS prescriber education and training programs and proposals for potential future activities through programs such as Medicare.

Encouraging Safe Pain Management Approaches:  

HHS continues to work to better educate providers and patients about safe pain management. Health care providers have expressed concern that scores on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey pain management questions are tied to Medicare payments to hospitals, even though those payments currently have a very limited connection to the survey’s pain management questions. However, to prevent any potential confusion on the part of providers, the Centers for Medicare and Medicaid Services (CMS) is proposing to remove the HCAHPS survey pain management questions from the hospital scoring calculation. This means that hospitals would continue to use the questions to survey patients about their in-patient pain management experience, but these questions would not affect the level of payment hospitals receive.

Accelerating Research on Pain and Opioid Misuse and Overdose:  

HHS is launching more than a dozen new scientific studies on opioid abuse and pain treatment to help fill knowledge gaps and further improve the Administration’s ability to fight this epidemic. As part of this announcement, the Department will release a report and inventory on the opioid abuse and pain treatment research being conducted or funded by its agencies in order to provide policy-makers, researchers, and other stakeholders with the full scope of HHS activities in this area.

Expanding Telemedicine in Rural America:

Last week, the Department of Agriculture announced nearly $1.4 million for five Distance Learning and Telemedicine (DLT) grant awards to Kentucky, Tennessee and Virginia to help rural areas address the opioid epidemic. USDA plans to announce funding for additional DLT projects this summer. In addition to DLT investments, USDA Rural Development has funded rural hospitals and health care clinics from its Community Facilities and Business and Industry Guaranteed Loan Programs. These projects provide communities with much-needed services to help address health care, including overdose and opioid use disorder.

Safely Disposing of Unneeded Prescription Opioids:

The Drug Enforcement Administration (DEA) has announced it will hold its 12th National Prescription Drug Take-Back Day on Saturday, October 22, providing a safe, convenient, and responsible way of disposing of unneeded prescription drugs. More than 6.4 million pounds of medication have been collected over the last eleven Take Back Days. Local communities and some pharmacies are also establishing ongoing drug take-back programs.  

Improving Housing Support for Americans in Recovery: 

The Department of Housing and Urban Development, in partnership with the U.S. Interagency Council on Homelessness and HHS, is identifying best practices to support individuals using medication-assisted treatment in programs funded through HUD’s Homelessness Assistance Grants to promote replication of best practices throughout the country.  HUD also will work with its Continuums of Care partners to help individuals with prescription opioid or heroin use disorders and use housing to support recovery. 

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