P

resident Trump’s remarks Thursday that he was directing his administration to declare the opioid epidemic a public health emergency mostly focused on the extent of the problem and highlighted in broad strokes that the country would find ways to combat the crisis.

But Trump also laid out ways in which his administration would be attempting to combat the opioid epidemic.

Here are a few of the steps Trump mentioned.

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Treatment beds

By law, federal Medicaid dollars cannot go to facilities that treat mental illness or substance use disorders if they have more than 16 beds, a policy that dates to a time when federal officials did not want to be in the practice of reimbursing state psychiatric hospitals. But with the opioid epidemic, some advocates have called for abandoning this policy.

Trump said that his administration would announce a new policy that would “overcome” the rule, suggesting officials would focus on granting waivers that allow states to expand treatment options.

The Obama administration in 2015 started offering waivers that states could apply for so larger clinics get reimbursed, and at least four states have received waivers to improve access to treatment. Trump seemed to suggest that his administration’s policy would be focused on expediting the process.

“Those approvals will come very, very fast,” Trump said.

Changing the policy entirely — which is known as the IMD exclusion — would take congressional action.

“While clearly overturning it may not be in the scope of what the executive branch can do, laying out a clear vision for how waivers could be used to improve the system on a state-by-state basis would be a significant and welcome improvement,” Matt Salo, the executive director of the National Association of Medicaid Directors, wrote in an email to STAT after Trump’s address.

There are some concerns that inpatient treatment should not always be prioritized, and that treatment in such facilities takes people out of their communities, which can provide a stable source of support for people embarking on recovery. Many advocates who favor changing Medicaid rules have also noted that Trump’s administration has backed cutting and reshaping Medicaid in a way that would lead to fewer people having coverage overall.

Prescriber training

Trump said he would require prescribers who work for the federal government to “receive, finally, special training” for prescribing opioids. It’s not clear what sort of education campaign Trump is envisioning, but the Obama administration in 2015 also announced a training program in opioid prescribing for prescribers who worked for the federal government.

Pain treatment

Federal health officials are going to launch a task force to come up with best practices for treating pain, Trump announced. This speaks to something that is often lost when discussing the opioid epidemic: There are still lots of patients who need pain medication, and there are some concerns that because of new prescribing limits and the fear of feeding addiction, they are not able to get access to them.

Whatever best practices the task force comes up with will likely be scrutinized by advocates both for pain patients who worry about not being able to get medication they feel they need and those who support stronger prescribing limits. (At the event, Trump highlighted CVS Caremark’s recent announcement that it was imposing prescription limits for first-time opioid prescriptions.)

‘Bad actors’

Trump said the federal government will “pretty soon” start suing “bad actors,” including people and companies that are “hurting our people.” He offered no specific details, but dozens of cities, counties, and states have filed lawsuits against drug makers and drug distributors for their alleged roles in seeding the opioid crisis.

Public education

Trump said “it’s really, really easy” not to use drugs if you never start — and suggested public education would be an important strategy for the government.

He told the story of his brother Fred, who struggled with alcoholism and died in his 40s from complications of the disease; Fred’s life instilled in Trump the commitment to never drink and never smoke.

But that’s also an explanation that overlooks how some people become addicted to opioids. Although the epidemic is increasingly being driven by heroin and the illicit use of synthetic opioids like fentanyl, many people developed addictions after being prescribed opioids by their doctors for legitimate pain treatment — a fact that first lady Melania Trump highlighted as she told stories of people she had met has she has learned more about the epidemic. Those people did not have a choice to, as Trump said, “not to take drugs, just not to take them.”

Meanwhile, Trump’s opioid commission, led by New Jersey Gov. Chris Christie, is set to release its final recommendations on Nov. 1. Trump said he will move to implement appropriate recommendations.

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  • From all that I’ve read, the Trump declaration of an emergency is basically as bogus as the prevailing war against pain patients. The President’s Commission on Combating Addiction and the Opioid Crisis was stacked with politicians who couldn’t find their collective tail ends using both hands on a sunny day — at least with regard to the causes and remedies for addiction.

    Dr Carl Hart – Chairman of the Department of Psychology at Columbia University – offers us a much needed public counterpoint to the nonsense being preached by our politicians, in the November issue of Scientific American. The title is “People Are Dying Because of Ignorance – Not Because of Opioids”. A key statement is as follows:

    “The vast majority of opioid users do not become addicts. Users’ chances of becoming addicted increase if they are white, male, young and unemployed and if they have co-occurring psychiatric disorders. That is why it is critical to conduct a thorough assessment of patients entering treatment, paying particular attention to these factors rather than simply focusing on the unrealistic goal of eliminating opioids.”

    We already know what works and what doesn’t. The Christie Commission should have paid attention and clearly didn’t.

    28-Day Detox or Rehab clinics don’t work alone. Neither do abstinence-based programs like Narcotics Anonymous. Relapse rates in both programs approach 90% in the first year, when addicts are discharged into communities without support for re-integration.

    The most effective means we have for managing addiction at present are medication-assisted therapies (Methadone, possibly Naloxone if prices can be greatly reduced) accompanied by ongoing counseling, safe housing initiatives, and job training. We also need aggressive and sustained counter-drug education starting in Middle Schools and including addicts as teachers. The costs of this combination of programs will likely be in the tens of Billions of dollars per year for the foreseeable future. Any proposal that lacks funding at this level will be a mere smoke screen without useful outcomes. That’s essentially what President Trump has proposed thus far.

    There is no such thing as a “former” addict or a “former” alcoholic. There are only addicts in recovery, many of whom will relapse because of being returned to the very same social and home life conditions which created their mental health issues in the first place.

  • According to the daily show all he has done is to free 57k$, declaring a public health emergency, to fight the opioid crisis. Instead of the much hoped and promised national emergency (with 23B$ funds) to fight it.

    So, it seems it was another Trump’s bluff!

    On the other hand, the daily show is FAKE NEWS!

  • I’m certainly glad to see the president is aware of the importance in access to opioids in treating chronic intractable pain patients like me, I want him to implement protection for us and our healthcare providers

  • These Government agencies are fighting chronic pain disease patients. We use legitimate prescription medications for diseases that cause us debilitating excruciating pain. The crisis is that they are targeting CHRONIC PAIN PATIENTS and the physicians that have enough compassion and empathy too treat us. Chronic pain is now the epidemic. We are being caterogized and descriminated against for a medication we require to reduce our pain. No other chronic disease patient is targeted for their use of prescription medication.
    What about the good of opioid medications. They are lifesaving medications for millions of Americans who live in constant, debilitating, chronic pain.
    Though the number of prescribed opioids are down, the overdose deaths are “reportedly, at an all time high”. So this system is not working.
    When a death does occur, there is no specific testing as to what opioid drugs attibuted to the death. Whether there were other drugs or alcohol in the system or whether the specific “medication” was for that individual. Was it illegally manufactured and distributed heroin, fentynal or carfentynal.
    The misuse of medication by legitimate chronic pain disease patients is .02-.6 %. It is use of illegal opioids and misuse of legal opioid medications that lead to addiction and/or death.
    The FDA, DEA, CDC and all other Government agencies need to go after the illegal fentynal and heroin producers and manufacturers, also, methamphetamine, cocaine and all other illegal drugs.
    Why is it that our physicians are no longer able to Doctor and treat us? Why is it that these agencies can now Doctor us and practice medicine without a medical license? What has happened to Doctor/patient confidentiality. It no longer excists. Pharmacists, insurance companies and these Government agencies are now able to decide what us patients actually need when it comes to our medications. They are policing our physicians. It is up to our physicians to treat us adequately and humanely with medication so many of us desperately need for our disease.
    This targeting is wrong! It is discrimination against legitimate chronic pain disease patients who use our MEDICATION responsibly.
    We pain disease patients are not addicts, we are PATIENTS, with incurable diseases. Medications are readily available to us for our conditions that happen to fall into the same category as the illegal drugs. Not treating us chronic pain disease patients is inhumane and discriminatory.
    The words used in news papers or on the news stations is “opioids”, why not specify? What should be used is heroin or illegal fentynal. These illegal drugs are being smuggled into this country by the boatload. It’s too difficult for the DEA to actually catch and prosecute these individuals. Us patients and our physicians are easy targets for prosecution. This is a war on us in need. We patients who are in pain. We deserve relief. Our physicians deserve to treat us as they see fit without threat of prosecution for doing their jobs and treating us with care, empathy, respect and caring.

    • In response to Candi pointing out that people are dying from illegal opioids yet legal opioids, prescribers and patients are being targeted. My doctor told me to “put my money glasses on” or in other words follow the money and that alot of the hysteria is being fed by insurance companies and the like who are trying to cut costs.

  • “Because of new prescribing limits and the fear of feeding addiction, they are not able to get access to [opioid pain medication].”

    That’s my fear. I suffer from chronic pain. When govenments get involved in things like this, they often go way overboard. In which case I couildn’t het the meds I need and would be in constant, serious pain plus I would be going through opioid withdrawal, with all those nasty problems: headaches, muscle aches, vomiting, disrupted sleep etc.

    I welcome suggestions for other ways of treating my pain. But I already suffer liver problems, and some meds can really harm my liver.

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