WASHINGTON — President Trump’s commission on combating the opioid epidemic plans to encourage the federal government to establish drug courts in every federal judicial district, adjust reimbursement rates for addiction treatment, and streamline federal funding used by state and local governments to implement drug treatment and prevention programs, according to a draft of the panel’s final report.
Those steps are among the 53 recommendations laid out in the draft, a copy of which was obtained by STAT. The final report is set to be released on Wednesday.
Drug courts in all federal judicial districts
As of 2015, according to the commission, less than one-third of federal judicial districts and 44 percent of U.S. counties operated drug courts, which serve as alternatives to the traditional court system and have been shown to increase engagement in addiction treatment and reduce recidivism rates. The commission will recommend the Department of Justice establish drug courts in every federal district, and that individuals with substance use disorder who violate probation terms be diverted to a drug court as opposed to prison.
Drug courts combine elements of criminal justice and addiction treatment to help those with substance use disorder avoid criminal sentencing, provided participants comply with a treatment course that can include counseling and medication-assisted treatment.
Streamline federal funding opportunities
Staffers in nearly nearly every governor’s office, according to the report, expressed concern about opioid-related funding from the federal government being “fragmented.”
The commission will recommend a system for distributing federal funding that expands and mirrors the process for obtaining block grants offered by the Substance Abuse and Mental Health Services Administration. That process should require only one application and result in states receiving at least equivalent funding while allowing them to redirect resources currently used for paperwork toward program implementation.
Changes to reimbursement rates set by federal addiction treatment providers
The commission will recommend that the Centers for Medicare and Medicaid Services review policies that incentivize the prescription of opioids over more expensive non-opioid treatments.
It will also urge the Department of Health and Human Services to review its rates to more adequately measure and cover the “true costs” of treating substance use disorder, including use of inpatient psychiatric facilities.
The report recommends lowering barriers to substance use disorder treatment, including those that impose limits on access to any of the three forms of medication-assisted treatment approved by the Food and Drug Administration. Separately, the report recommends increasing access to recovery coaches.
Allow more emergency responders to administer naloxone
A best-practices guide issued by the National Highway Traffic Safety Administration — which oversees the federal Office of Emergency Medical Services — currently recommends that paramedics and advanced medical technicians be allowed by local communities to administer naloxone, the overdose-reversal drug. The report recommends the those guidelines be reviewed to allow emergency medical technicians to also administer the medication, and in higher doses.
Several states currently prohibit some classifications of emergency responders from administering naloxone.
Tighten requirements for prescribers
The report will recommend the Drug Enforcement Administration require prescribers seeking to renew licenses to prescribe opioids first demonstrate they have participated in an education program regarding the drugs’ prescription. The report also recommends that HHS develop a “national curriculum and standard of care for opioid prescribers,” and that pharmacists receive training “on best practices to evaluate the legitimacy of opioid prescriptions.”
Eliminating patient pain evaluations from surveys
The commission will recommend that CMS eliminate questions about pain levels from patient satisfaction surveys, thereby ensuring that providers are not incentivized to prescribe opioids in order to increase measured patient approval.
Steps to ensure parity
The draft report says federal and state regulators should have better ways of measuring health providers’ compliance with parity laws, which require providers to provide and fund services for mental health and addiction on an equal basis to other health conditions.
The White House, the commission will recommend, should fund and coordinate with private-sector and nonprofit groups to implement a “wide-reaching, national multi-platform media campaign addressing addiction stigma and the danger of opioids.” The report likens the effort to a similar initiative launched during the HIV/AIDS epidemic of the 1980s and 1990s.
In another prevention initiative, the report recommends a collaboration between states and the Department of Education to implement student assessment programs to identify at-risk youth in middle school, high school, and college in need of treatment.
The report will also recommend implementing policies that ensure patients are adequately educated about the “risks, benefits, and alternatives of taking opioids” before receiving an opioid prescription for chronic pain.
Expand compliance with the Prescription Drug Monitoring Act
The report will push the White House to endorse the Prescription Drug Monitoring Act, legislation currently before Congress that would require states receiving federal grant money to comply with regulations for prescription drug monitoring programs and share data with a national hub to be established by the Department of Justice.
Separately, the commission recommended integrating PDMP data with electronic health records systems, and that the DEA and the Office of National Drug Control Policy increase electronic prescribing to prevent forgery and drug diversion.
Better data on overdose deaths
“We do not have sufficiently accurate data from medical examiners around the country to determine overdose deaths,” the report reads. It directs the federal government to develop forensic and toxicology procedures for use while investigating drug-related deaths.
Leveraging Public Health Service personnel
The report recommends the White House deploy health care workers from the Public Health Service Commissioned Corps to administer treatment and care in areas with above-average opioid use.
Bolstering research money
The director of the National Institutes of Health, Francis Collins, has acknowledged already that while he hopes the agency will continue to play a major role in addressing the drug crisis, it will be unable to significantly do so by merely redirecting some of its current funding. The commission agrees, and cited three institutes within NIH it deems worthy of increased research funding: the National Institute on Drug Abuse, National Institute of Mental Health, and National Institute on Alcohol Abuse and Alcoholism. It did not specify recommended funding levels.