Trump opioid order sees role for telemedicine, remote prescribing
President Donald Trump on Thursday officially declared the opioid epidemic a national public health emergency under federal law. Industry groups were quick to support the executive action to address the crisis, while calling on the White House and Congress to more fully leverage technology and allow the sharing of patient substance use records.
In making the announcement, Trump said the declaration directs all executive agencies to use every appropriate emergency authority to fight the opioid crisis. Specifically, it “allows for expanded access to telemedicine services, including services involving remote prescribing of medicine commonly used for substance abuse or mental health treatment.”
Trump referenced the President’s Commission on Combating Drug Addiction and the Opioid Crisis, adding that he eagerly awaits the commission’s final report—which is expected next week—so that he can review their findings and recommendations.
“After we review and evaluate the commission’s findings, I will quickly move to implement approximate and appropriate recommendations,” added Trump.
An interim report from the commission released at the end of July called on Trump to declare the opioid epidemic a national emergency and 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.
The commission’s interim report also took aim at Title 42 of the Code of Federal Regulations Part 2 (42 CFR Part 2) which requires addiction treatment professionals to obtain written patient consent before sharing any information with a patient’s other healthcare providers. The report criticized 42 CFR Part 2 as a hindrance to comprehensive healthcare and called it a misguided law preventing doctors from knowing their patients’ addiction treatment histories.
Nonetheless, Trump’s declaration on Thursday made no mention of PDMPs or 42 CFR Part 2. It was an omission seized upon by Health IT Now, a coalition of patient groups, provider organizations, employers and payers.
“While provisions in the president’s directive expanding access to treatment via telehealth are a welcome and laudable reform, we believe the Administration should take additional steps to leverage technology to fight back the tide of this epidemic,” said Joel White, executive director of HITN. “This includes policies to allow for fully interoperable prescription drug monitoring programs (PDMPs) with real-time updates that will be queried at both the doctor’s office and the pharmacy counter, in order to stop opioid abuse before it occurs.”
In addition, White called on Congress to “reform the overly broad federal regulation known as 42 CFR Part 2 that has prevented providers from knowing critical, relevant information about a patient’s past addiction.”
Premier, a healthcare alliance of 3,900 hospitals and 150,000 other providers, said it strongly supports the President’s declaration of the opioid epidemic as a public health emergency. According to Blair Childs, senior vice president of public affairs at Premier, the action will serve to “ease regulations, allowing state and local officials to redirect funds to address the epidemic as well as expands use of telemedicine to treat those with opioid addiction.”
Childs added that Premier is focused on removing policy impediments that create barriers in tackling the opioid epidemic. “In particular, we strongly encourage lawmakers to pass legislation (S.1850 and H.R.3545) that would align 42 CFR Part 2 with HIPAA for the purposes of healthcare treatment, payment and operations, allowing CMS and other payers to share key information on patients’ substance use to their providers and enable better and safer care management,” he said. “The bill reforms an outdated 1970s law that prevents clinicians from gaining access to data on patients with substance use diagnosis.”
The American Hospital Association said it welcomed the White House announcement of a public health emergency.
“We urge the Administration and Congress to take needed steps, such as eliminating the barriers to treatment created by the Medicaid Institutions for Mental Disease (IMD) exclusion, knocking down impediments to the appropriate sharing of patient substance use records, and ensuring that patients have comprehensive coverage that facilitates access to the services they need,” said Rick Pollack, president and CEO of the AHA. “We also urge full funding and implementation of legislation previously enacted to help end the epidemic.”
Although the American Medical Association commended Trump for declaring the opioid epidemic a public health emergency, Patrice Harris, MD, chair of the AMA Opioid Task Force said the declaration alone won’t solve the problem.
“Ending the epidemic will require physicians, insurers, drug manufacturers and the government to follow through with resources, evidence-based treatment plans, and smart public policies at the national and state levels,” said Harris. “As physicians, we must be leaders in continuing to make judicious prescribing decisions, and by considering the full range of effective therapies for pain, including non-opioid and non-pharmacologic options, co-prescribing naloxone, helping patients access medication-assisted treatment for opioid use disorder and removing stigma.”