ONDCP Releases 2020 National Drug Control Strategy
On Monday, the White House Office of National Drug Control Policy released its 2020 National Drug Control Strategy, an annual document used to help identify and prioritize the Administration’s priorities related to illicit drug use, trafficking and treatment of substance use disorders for the year ahead. As part of the Administration’s comprehensive plan to address the opioid epidemic, the White House is aiming to reduce drug overdose-related deaths by 15% in 2020 – which would drop the annual count below 60% and nearly quadruple the 4.1% drop experienced in 2018. Furthermore, the Administration outlines its intent to double access to medication-assisted treatment, improve the number of providers waivered to prescribe MAT, and continue its reduction of opioid prescribing in general – 33% by 2020.
ONDCP Director Jim Carroll, upon release of the report noted, “The 2020 National Drug Control Strategy maintains focus on President Trump’s overarching goal from day one – reducing the number of Americans dying from drug overdoses. While the Trump Administration has made significant progress in preventing substance misuse before it starts, getting more people into treatment and long-term recovery, and curbing the flow of deadly drugs into our communities, now is not the time to rest on this success.”
Following the release of the NDCS and related materials, House Oversight and Reform Committee Chairwoman Carolyn Maloney (D-NY) announced a February 27th hearing with ONDCP Director Jim Carroll on the strategy and related efforts within the Administration to tackle the opioid epidemic. In her statement, Chairwoman Maloney recognized the decrease in drug-related overdose deaths in 2018 and encouraged greater reliance on evidence-based treatment for substance use disorders.
Articles & Resources
LINK – 2020 National Drug Control Strategy
LINK – 2020 National Treatment Plan for Substance Use Disorder 2020
House Committee on Oversight and Reform – Maloney Announces Hearing with ONDCP Director on 2020 White House Drug Strategy
CMS Revisions to MA and Part D Target Opioid Policies
The Centers for Medicare & Medicaid Services (CMS) this week announced the release of a proposed rule and advance notice regarding efforts to strengthen the Medicare Advantage and Part D programs. Several pieces of the proposed changes revolve around various provisions within the SUPPORT for Patients and Communities Act and ongoing efforts to combat the opioid epidemic within these beneficiaries. Specifically, the proposed rule highlights efforts to improve beneficiary education – Section 6103 – focused on risks of controlled substances, alternatives to pain treatment and safe disposal practices. Furthermore, there will be increased scrutiny on prescribing practices through expanded rug management and medication therapy management program utilization to better track prescribing and dispensation trends.
Articles & Resources
LINK – Federal Register Notice
CMS Newsroom – Proposed Changes to Medicare Advantage and Part D Will Provide Better Coverage, More Access, and Improved Transparency for Medicare Beneficiaries
HHS-OIG Continues Focus on Comprehensive Opioid Treatment Response
Over the last weeks, the Department of Health and Human Services Office of Inspector General released two reports targeting core components of the opioid epidemic response: access to medication-assisted treatment (MAT) and provision of OUD care at opioid treatment programs (OTPs). On Monday, HHS-OIG focused on access to buprenorphine nationwide and remaining geographic disparities related to access and physician shortage. Amid ongoing federal efforts to improve access to MAT and increase the number of eligible prescribers, data provided by SAMHSA indicated that many localities within the United States still have a dearth of SUD treatment expertise. The U.S. currently has the greatest level of waivered physicians offering MAT, however it is estimated that 40% of all U.S. counties do not have a single DATA 2000-waivered physician and are not clustered in areas where the provision of care is most important. HHS OIG indicated that 56% of the nearly 1,100 counties identified as needed buprenorphine-related services lacked adequate capacity to provide substantive evidence-based care.
On Thursday, OIG followed its earlier report in highlighting findings around the provision of SUD treatment at Opioid Treatment Programs in New York State and improper claims totaling more than $39 million covered by the Federal Government. As part of its oversight of federal funds distributed to help abate the opioid epidemic, OIG identified issues with a portion of the state’s claims for Medicaid reimbursement. Looking at a representative sample of nearly 11 million claims, OIG found that many did not comply with relevant state and federal requirements which led the agency to recommend that New York refund those claims reimbursements to the federal government and develop a better infrastructure for oversight going forward.
Articles & Resources
HHS Office of the Inspector General – Geographic Disparities Affect Access to Buprenorphine Services for Opioid Use Disorder
HHS Office of the Inspector General – New York Claimed Tens of Millions of Dollars for Opioid Treatment Program Services That Did Not Comply With Medicaid Requirements Intended To Ensure the Quality of Care Provided to Beneficiaries
JAMA Publications Highlight Efforts to Improve Evidence Base for Overdose Reversal Meds and MAT
The Journal of the American Medical Association last week published three important peer-reviewed articles focused on key components of combatting the opioid epidemic: access to naloxone and use of evidence-based interventions to treat opioid use disorders.
Looking specifically to Ohio, researchers found that a July 2015 General Assembly law that allowed pharmacists to provide naloxone without a prescription positively impacted the quantity of naloxone distributed throughout the state. In total, Ohio saw a 2,328% increase in dispensing, and an 18% bump within Ohio Medicaid. At the end of the review, researchers identified 4,637 naloxone orders dispensed in 2017; up from a mere 191 orders in 2015 prior to the implementation of the law.
On Thursday, JAMA Psychiatry subsequently released a review of six total interventions for opioid use disorder ranging from no treatment whatsoever, initiation of MAT, and behavioral health interventions (both intensive and non-intensive). Looking specifically at overdose rates or significant relapse in the 3- and 12-month period after treatment initiation, researchers found that only buprenorphine and methadone demonstrated a statistically significant improvement in risk reduction in those periods. Additional efforts are required to better understand use of medication and other behavioral health interventions to address opioid use disorders while recognizing the continued build-out of a comprehensive evidence base to support thoughtful and impactful policy development. In the same issue, researchers published a retrospective analysis of claims data related to more than 230,000 admissions to residential treatment facilities and concurrent MAT utilization. Researchers identified that less than 50% of those admitted were offered MAT. Breaking down the data further, less than 18% of patients in Medicaid expansion states received MAT and less than 2% in states that had not expanded Medicaid. Overall, use of naltrexone, buprenorphine and methadone remains unavailable to a significant portion of U.S. patients coupled with even lesser utilization.
Articles & Resources
Journal of the American Medical Association – Association Between a State Law Allowing Pharmacists to Dispense Naloxone Without a Prescription and Naloxone Dispensing Rates
Journal of the American Medical Association | Psychiatry – Comparative Effectiveness of Different Treatment Pathways for Opioid Use Disorder
Journal of the American Medical Association | Psychiatry – Differences in Availability and Use of MAT in Residential Treatment Settings
Join Safe States Alliance’s Annual Advocacy Day – March 6th
Safe States Alliance, in concert with the Injury and Violence Prevention Network and the American College of Preventive Medicine, invites you to participate at its annual Advocacy Day on March 6, 2020 in Washington, DC. The event focuses on educating lawmakers about the impact injury and violence prevention programs have on the communities they represent. The day will begin with a breakfast briefing where detailed information will be shared on how to conduct congressional visits and what to expect from your day on the Hill. Safe States will schedule all appointments and provide issue briefs on various injury and violence prevention programs. Please register to attend and join your colleagues on Capitol Hill to strengthen the voice in support of injury and violence prevention policy! Learn more.
House Passes Extension of Fentanyl Scheduling Bill
In a 320-88 vote this week, the House passed S. 3201, extending DEA’s temporary ban on all fentanyl analogues and similar entities for fifteen months. Over the last several weeks, the bill had riled up some progressive lawmakers and other allied parties around potential over-criminalization due to mandatory minimum sentences included as part of the existing authority. During the last several weeks, members of the Department of Justice and U.S. Attorney’s offices urged the House to pass this bill and more permanently classify fentanyl analogues as a Schedule I drug. The bill had been passed out of the Senate by unanimous consent on January 16th and will now go to the President’s desk before it is set to expire on February 6th.
Articles & Resources
S.3201 – Temporary Reauthorization and Study of the Emergency Scheduling of Fentanyl Analogues
New York Times – U.S. House Passes Bill to Extend Temporary Ban on Fentanyl Look-Alikes for 15 Months
Bloomberg – House Splits Over Extending Federal Fentanyl-Banning Powers
What We Read Last Week
Several articles were published last week pertaining to the opioid epidemic, covering a variety of different components of the issue. Links to relevant articles are provided below.
Articles & Resources
SIGN ON LETTER OPPORTUNITY (attached): Extending the Certified Community Behavioral Health Clinic Demonstration – Please contact Malka Berro at the National Council for Behavioral Health to add your name.
National Safety Council – Research Review on Youth Prescription Opioid Misuse Finds Opportunities for More Investment in Targeted Prevention
New York Times – A Fake Pharmacist, 745,000 Prescriptions and a $7.5 Million Settlement
Kaiser Health News – Good Rehab is Hard to Find
Philadelphia Inquirer – This Addiction Treatment is Often Sold on the Streets And May Be Preventing Overdoses
Inside Health Policy – House Oversight Again Probing White House Opioid Strategy
Bloomberg Government – Opioid Trials Set for San Francisco, Cherokee Nation in Oklahoma
The Journals of Gerontology (Series A) – Opioid Use and the Risk of Falls, Fall Injuries and Fractures among Older Adults: A Systematic Review and Meta-Analysis
Law360 – JPML Ships Opioid Bellwethers Over Drug Co. Protests
White House Newsroom – United States-Canada Statement on Joint Action Plan on Opioids
White House Newsroom – Bill Announcement: President Trump Signs Into Law S. 3201 – The Temporary Reauthorization and Study of the Emergency Scheduling of Fentanyl Analogues Act
Department of Treasury – Treasury Announces 2020 National Illicit Finance Strategy
Department of Justice – Four Detroit-Area Physicians Found Guilty of Health Care Fraud Charges for Role in Over $150 Million Health Care Fraud Scheme
Department of Justice – Federal Court Orders North Carolina Pharmacy and Pharmacist to Pay $600,000 and to Permanently Cease Dispensing Opioids or Other Controlled Substances
U.S. Attorney for the Southern District of West Virginia – HOPE Clinic Physician Pleads Guilty to Drug Crime
U.S. Attorney for the Western District of Pennsylvania – Greensburg Doctor Charged with Conspiring to Receive Kickbacks for Prescribing Fentanyl, and Then Causing Insurers to Pay for the Unlawful Prescriptions
This Week’s Calendar
While the House and Senate are both in session this week, there are no opioid-related events noticed at this time. Should there be any additions to House or Senate schedules or updates with respect to additional events, this information will be made available.
Questions about the above content can be directed to Matthew.Rubin@FaegreDrinker.com.