August 7th, 2017

A Win For The Trump Administration

The “Draft Interim Report” of the President’s Commission on Combating Drug Addiction and the Opioid Crisis was presented at the second meeting of the Commission on July 31st and was worth the wait. I have written impatiently on this site about the lack of action by the Trump Administration regarding the problem of drug addiction and am glad at last to have something to praise.

There are several recommendations that I particularly want to highlight:

  • Declare a national public health emergency
    • There is already substantial media attention focused on the opioid addiction problem, but such a declaration would allow the allocation of funds and other resources to deal with the problem.
  • Expand addiction treatment capacity
    • Priority should be given to filling unused outpatient treatment slots before automatically spending more money to increase the number of treatment “beds,” which are so costly that they should be reserved for those whose conditions are too severe to benefit from outpatient withdrawal management and rehabilitation.
  • Mandate prescriber education on opioids
    • This is long overdue having been delayed by the effective but counterproductive efforts of the American Medical Association.
  • Fund access to medication-assisted treatment, including all 3 FDA approved medication options
    • Residual ideological bias persists toward methadone and buprenorphine, aided by unscrupulous lobbying against these medications by Alkermes, the pharmaceutical manufacturer of Vivitrol.
  • Increase interstate capacity of Prescription Drug Monitoring Programs (PDMP)
    • This is necessary to prevent people from doctor shopping across state lines. Funds are needed to allow the state plans to communicate with other electronically.
  • Enforce parity for behavioral health
    • Laws regarding parity took many years to pass and implementation is the next step. Parity should not, however, be used as a pretext for unnecessary inpatient treatment. At a time of concern about rising healthcare costs, all of medicine is moving toward using resources wisely, whether for diabetes or surgery, by expanding the use of outpatient services.

The focus on treatment and public health was particularly welcome given the emphasis on increased law enforcement urged by DOJ Attorney General Sessions, which I believe to be misguided and counterproductive. These two approaches can be used collaboratively rather than competitively but requires careful thought and emotional restraint. I will be watching and reporting to you regarding the final report, scheduled for October, and whether the Administration, in fact, implements these excellent recommendations.

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