Colorado Medical Society

http://dev.cms.org/articles/prescription-drug-abuse5/

Prescription drug abuse

Thursday, September 01, 2016 12:30 PM

Overdoses from heroin, prescription drugs and opioid pain relievers last year surpassed car accidents as the leading cause of injury-related death in America, according to the Centers for Disease Control. Heroin overdoses have more than tripled in the last five years, receiving increased attention nationally and within the state of Colorado, one of the hardest-hit states.

New bipartisan legislation opens new funding streams in the fight against this epidemic. The Comprehensive Addiction and Recovery Act (CARA), S. 524 and H.R. 953, was introduced by Sen. Sheldon Whitehouse (D-RI) and Rep. Jim Sensenbrenner (R-WI), and passed Congress on July 13. It was signed into law by President Barack Obama on July 22.

This federal legislation authorizes the attorney general and secretary of Health and Human Services to award more than $181 million in grants to address the national epidemics of prescription opioid abuse and heroin use. Funds must be appropriated every year through the regular appropriations process.

The new law:

• Establishes a task force to review, modify and update best practices for pain management and prescribing pain medications.
• Provides grants for state awareness campaigns and training.
• Requires the FDA to consult with advisory committees prior to approval or labeling of certain new opioids in pediatric populations and to provide final guidance for generic drugs that claim abuse deterrence within 18 months of the date of enactment.
• Authorizes the attorney general to expand disposal sites.
• Creates a pilot program to support family-based services for pregnant and postpartum women with substance use disorders, and creates a study of the prevalence of neonatal abstinence syndrome.
• Permits grants to states to carry out a comprehensive opioid abuse response.
• Requires a study of state Good Samaritan Laws with regard to exemption from criminal or civil liability for someone who administers an opioid overdose reversal drug or device, or who calls 911 to report an overdose.
• Allows prescription drug plans in Medicare to develop a safe prescribing and dispensing program for beneficiaries who are at risk of abuse or diversion of drugs that are frequently abused or diverted.
• Allows the secretary of Health and Human Services to work with private drug plan sponsors to facilitate the creation and management of “lock-in” programs to curb identified fraud, abuse and misuse of prescribed medications.
• Authorizes Medicare Integrity Contractors (MEDICs) to directly accept prescriptions and necessary medical records from entities such as pharmacies and physicians.
• Exempts abuse deterrent formulations of opioid drugs from the definition of “line extension” for the purpose of calculating Medicaid rebates.
• Expands the use of routine and random drug tests for all VA patients during and after opioid therapy.
• Requires that VA providers disclose certain information to state controlled substance monitoring programs.
• Eliminates the copayment requirement for veterans receiving opioid antagonists or education on the use of opioid antagonists.
• Allows partial filling of opioid prescriptions.
• Permits nurse practitioners and physician assistants to administer medication-assisted treatment for opioid use disorder, with physician oversight if mandated by state law.
• Authorizes multiyear funding for the Department of Justice to issue grants to states, local government 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.

Rob Valuck, PhD, RPh, chair of the Colorado Consortium for Prescription Drug Abuse Prevention, said that while there are many useful pieces in the new law, the two biggest disappointments are that it’s severely underfunded and there isn’t much funding targeted for treatment and prevention.

“The problem is very complicated and has so many different dimensions to it. There are so many places where you could focus your efforts and all are worthwhile in some way. That’s why you see legislation like CARA, which is a whole bunch of different pieces put together. It’s a hodgepodge.”

Additionally, with the consortium leading the effort in our state, Colorado leaders are already either aware of most of the recommendations in the bill or already actively working on them. “What we’re hoping for is more funding, especially for things like more Naloxone so that high-risk people have an opportunity to get into treatment.” The treatment gap – a term for the number of people who need care and are ready and able to access it but who cannot get care – stands at 80-85 percent in the U.S., down from 93 percent two years ago, Valuck said.

Because of the treatment gap, the consortium is urging Colorado physicians to be trained to provide medication-assisted treatment (MAT) with Suboxone (buprenorphine and naloxone). Physicians need only to fill out a form and complete an online eight-hour training module available through the American Society of Addiction Medicine (ASAM) to start seeing these patients, Valuck said. Access the ASAM Buprenorphine Course for Office-Based Treatment of Opioid Use Disorders training at www.asam.org/education/live-online-cme/buprenorphine-course. This method can be more convenient for patients without ready access to a methadone clinic, which requires daily visits, because Suboxone prescriptions can be written for a week or month supply.

This effort will be bolstered by an AHRQ grant awarded to the University of Colorado Denver. This project will expand access to MAT across 24 counties in Eastern and Southern Colorado, providing rural primary care practices with comprehensive training and support for delivery of MAT in their practices using face-to-face practice coaching and an ECHO tele-training model.

Learn more about the work of the Colorado Consortium for Prescription Drug Abuse Prevention on their website, www.corxconsortium.org.