President Donald Trump on Thursday declared the opioid epidemic a national emergency and instructed his Administration to use all appropriate authorities to respond to the crisis.
That paves the way for the Department of Health and Human Services and other agencies to step up efforts to fight drug abuse that has claimed the lives of more than 500,000 Americans so far this century.
“Today’s announcement demonstrates our sense of urgency to fight the scourge of addiction that is affecting all corners of this country,” said Health and Human Services Secretary Tom Price, MD. “Traveling the country, we have seen firsthand the devastation this crisis is inflicting on individuals, families and communities. President Trump’s announcement further punctuates his clear commitment to combating this epidemic.”
The executive action comes on the heels of a recently released interim report from the President’s Commission on Combating Drug Addiction and the Opioid Crisis, which made a number of recommendations including calling on Trump to declare the opioid epidemic a national emergency.
“After an emergency declaration by the President (and arguably even without it) the Department of Health and Human Services Secretary would be empowered to immediately grant waivers” for all 50 states to “quickly eliminate barriers to treatment resulting from the federal Institutes for Mental Diseases (IMD) exclusion within the Medicaid program,” states the report.
“This will immediately open treatment to thousands of Americans in existing facilities in all 50 states,” adds the commission. “This is the single fastest way to increase treatment availability across the nation.”
The commission, chaired by New Jersey Gov. Chris Christie, also recommended that the federal government provide funding and technical support to states to improve interstate data sharing between state-run prescription drug monitoring programs (PDMPs) to better track prescriptions written for addictive medications.
PDMPs record a patient’s opioid prescribing history and are used to flag suspicious activity. However, the commission charged that these databases are being “significantly underutilized” in the vast majority of states.
In addition, the presidential panel called for better aligning patient privacy laws specific to addiction with HIPAA to ensure that information about substance use disorders is made available to clinicians treating and prescribing medication for patients.
“Providers and other advocates have found that certain privacy regulations, while well-intentioned patient protections, act as a barrier to communication between providers, can make it difficult for family members to be involved in a loved one’s treatment, and limits the ability to use electronic health records to their full potential,” states the commission’s report.
Because of concerns about the potentially negative consequences that could come from disclosing the patient records of individuals with substance use disorders, Congress in 1975 passed Title 42 of the Code of Federal Regulations Part 2 (42 CFR Part 2) which required addiction treatment professionals to acquire written patient consent before sharing any information with a patient’s other healthcare providers.
However, the commission specifically pointed to 42 CFR Part 2 as a particular hindrance to comprehensive healthcare and a misguided law preventing doctors from knowing their patients’ addiction treatment histories.
“Making it administratively difficult for providers to share information has ill-effects on patients in both physical and behavioral health settings, by restraining physicians’ ability to make informed healthcare decisions,” concludes the report. “We urge you to direct that regulation be changed to permit the sharing of this type of information among healthcare providers and the loved ones of those suffering from substance use disorders. Otherwise, drugs with high abuse liability may be prescribed to people with opioid use disorders. That will lead to even more unnecessary and preventable deaths.”
Late last month, Rep. Tim Murphy (R-Penn.) introduced the Overdose Prevention and Patient Safety Act, which seeks to provide physicians with information to prevent overdose tragedies and protect patients by simplifying and aligning 42 CFR Part 2 with the existing confidentiality protections under HIPAA. Further, for those patients in recovery, the bill bolsters 42 CFR Part 2’s existing protections that prevent the disclosure of addiction treatment records in a manner that might lead to prosecution, loss of employment, housing, or child custody, as well as discrimination.
“Without this legislation, providers are ‘flying blind,’ barred from accessing this important element of the medical history,” said Blair Childs, senior vice president of public affairs for Premier. “Without full and complete information on patients’ substance use, we have effectively set up a two-tiered system—one where those struggling with addiction receive uncoordinated, incomplete care that can exacerbate their condition, lead to unnecessary emergency department visits and potentially even result in overdose. This is a particular issue for accountable care organizations, which are at financial risk for the costs and quality of patient outcomes.”
“We strongly encourage members of the House to pass this legislation swiftly in order to improve outcomes and remove this information barrier to responsible care,” added Childs. “With these changes to the law, providers will be able to proactively help patients get substance use treatments that can save lives.”
Likewise, in its interim report, the President’s Commission on Combating Drug Addiction and the Opioid Crisis references the Overdose Prevention and Patient Safety Act as a possible solution for reforming 42 CFR Part 2.
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