President’s letter: Working together on prescription drug abuse prevention

Monday, March 20, 2017 12:05 PM

by Katie Lozano, MD, FACR, President, Colorado Medical Society

As soon as Gov. John Hickenlooper publicly announced that reducing opioid misuse and abuse in Colorado would be one of his winnable battles, the Colorado Medical Society gave the governor our full cooperation and support in this worthwhile and overdue effort. Solving the opioid crisis is and will continue to be a substantial focus and a critical task for our medical society, and we are committed to solving this crisis for the people of Colorado.

Leading our efforts is the CMS Committee on Prescription Drug Abuse. In late February, our committee and CMS leadership met with Kyle Brown, PhD, senior health policy advisor to Gov. Hickenlooper, and Larry Wolk, MD, MSPH, executive director and chief medical officer of the Colorado Department of Public Health and Environment, to identify and recommend mechanisms to accelerate current efforts to combat the opioid crisis. Our lieutenant governor, Donna Lynne, recently completed a tour of 54 rural counties in our state where opioid misuse and abuse was routinely identified as a crisis issue. Continuing to recognize this crisis as a top priority, the committee met for an intense brainstorming exercise to identify additional workable solutions. Rob Valuck, PhD, chair of the Colorado Consortium for Prescription Drug Abuse Prevention, was honored at the meeting for his extensive work on this issue in partnership with CMS and his input was greatly appreciated. We also had many subspecialty groups represented at the meeting providing their input on how best to solve this problem.

The resulting proposed solutions reflect the group’s many years of experience and their expertise in patient care, pain management and addiction medicine. The goal was to find consensus and engagement on active solutions, and the members of the committee and guests were clearly engaged to achieve this goal.

1. Support the concept of Schedule II controlled substance partial fills.

One strategy to reduce diversion of legally prescribed opioids is to ensure that patients are prescribed the lowest effective dose for the shortest expected duration for expected pain following an acute injury or medical procedure. Some patients may not require medication for the full duration of expected pain. Patients and prescribers should be allowed to request a partial fill of a Schedule II controlled substance. It’s critical to avoid diversion of legally prescribed opioids because 75 percent of people who are newly addicted to opioids obtained access to those opioids from a friend or family member, according to the 2014 National Survey on Drug Use and Health.

2. Ensure compliance with the Substance Use Disorders Essential Health Benefits (EHB) provision of the Affordable Care Act.

There is broad evidence supporting the benefits of treatment for substance use disorders, but also similar evidence that the treatment often is lacking. An important step in state policy development should be a more aggressive focus on comprehensive treatment efforts. The federal Affordable Care Act provides that treatment for substance use disorders is an Essential Health Benefit (EHB). The Prescription Drug Abuse committee recommends that the Executive Branch ensure that the Colorado Division of Insurance is evaluating and proactively monitoring whether payers are providing the substance use disorder EHB, that the DOI is enforcing against payers who are not providing this to patients, and that payer networks provide adequate access to treatment from an addiction and mental health specialist for patients with substance use disorders in compliance with the EHB.

3. Support CMS working in the 2017 General Assembly and in coordination with the Executive Branch to identify and appropriate the necessary funds to upgrade the Prescription Drug Monitoring Program (PDMP) into a highly functional clinical tool.

The Colorado PDMP is inadequately funded, and the lack of funding directly impacts the functionality and use of the system at the point of care. A national survey of PDMPs shows that those systems that are easiest to use are also most effective in terms of the number of clinicians accessing them. These high-performing PDMPs are also well funded to allow for improvements in functionality.

4. Support continuing medical education goals in 2017.

The Prescription Drug Abuse committee supports continued CMS partnership with the Colorado Consortium for Prescription Drug Abuse Prevention, COPIC, the University of Colorado School of Public Health and other stakeholders to accelerate responsible opioid prescribing CME courses to Colorado physicians, building on successful programs of the past.

5. Support state legislation to provide the tools to fight the opioid crisis.

The Prescription Drug Abuse committee supports two bills under consideration by the state legislature: One that creates a pilot program in certain areas of the state that experience high levels of opioid addiction to award grants to increase access to medication-assisted treatment (MAT), and another that would allow funding to improve the PDMP and allow pharmacists as well as providers to contribute financially to the maintenance and operation of the program.

These recommendations went before the CMS Board of Directors on March 10 and were approved. I am grateful to all participants of the meeting and it is my hope that we seize this opportunity to accelerate the progress that is already underway in Colorado.