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ASHINGTON — 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.

The highlights:

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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.

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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.

Media campaign

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.

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  • I fear that this Opoid abuse commission with Gov Christie as chairman of it, will be about as effective as his membership on the voter fraud commission… Neither seems to deal with real life causes, just GOP wishful impressions…
    What a waste of Taxpayer dollars by the GOP plutocrats!!

  • This epidemic started with OxyContin, The Canadian Medical Journal in 1995, warned that OxyContin would become the most abused medication going forward. Patients never asked for OxyContin, Dr’s never asked for OxyContin, it was pushed on the American public by BigPharma and the US congress.
    Also, numerous physicians were convicted at the time for not prescribing enough painkillers to their patients, thanks to the scourge of trial lawyers.
    From the start most diversion happened at the wholesale level, by the truckload, unrelated to Dr. prescriptions.
    For decades the NY medical society had asked NYS to give Physicians access to the pharmacy databases, for all medications including narcotics, which was always denied.
    Belatedly, NYS passed I-stop unanimously, the perfect tool for any unethical provider selling prescriptions to make sure patients only shop with this provider, and at same time criminalizes honest Physicians.
    US congress in 2016 passed a law unanimously to keep the DEA from investigating unscrupulous drug distributors (see CBS 60 min DEA whistleblower).

    As per WHO only 2 countries in the world have seen a decline in the quality of healthcare since 1995. (the other one is South Africa, at the time segregation had ended, and many Physicians fled the country)

    Our Healthcare problems are not limited to opioids, trial lawyers, and BigPharma.
    A recent study in England found the use of cardiac stents mostly useless. Most properly trained Physicians already know this. Leaders in cardiology from Stanford, Mayo, and Cleveland were interviewed about this study, and publicly declared the findings “unbelievable”.

    Today, in obstetrics we are dealing with an exceptionally high cesarean section rate. Which should be no surprise considering the intense litigation in the 1970’s over cerebral palsy injuries.

    Numerous books, academic articles, editorials, and blogs have all discussed and predicted the current state of affairs over the years. Yet it is clear that, in the USA, marketing false hope, and greed, continue to outweigh independent decision making by well intended Physicians and their patients.

    Isn’t it is amazing how much progress was made in healthcare in the first half of the 20th century, compared to the last 50 years? Do we really belief its because Physicians don’t know how to use big data?

    As we continue to practise medicine from the bench, NYS recently passed almost unanimously a law to increase the statue of limitations to 7 years from the current 2.5 years, about to be signed by the Govenor Cuomo. The Governors sister is a Pediatrician, clearly at all levels common sense is out the door.

    • Since u put on your ,name,,u are ,”PROFESSIONAL,” then why is your comment geared at blaming a pill??Do u not believe in;” ‘informed consent,”as a Doctor?Also could u please explain how ANY medicine gets into a persons body via oral route??I mean someone has to life their arm,and put that pill in their own mouth,,right??Or is pharma,doc’s and nurse pinning patients down a shoving it down there throats??
      How about some facts here,,No-one shoves a medicine down anyones throats,,thats a fact.
      Informed Consent, was honored in this counry since is founding ,soo 311 years now,,for thee last 5,,it has NOT been honored in our court rooms,,If the government can hand these ADULTS a gun at 21,,and ,”assume,” they have the mental capacity to kill another humanbeing,,then why isn’t the same ideology applied when they are to be responsible for what they put in their own bodies?
      Fact,,if u look at ,”suicide data,” When pain management was 1st introduced ,say 1990,,thru 1999,,the death rate dropped by 4 %,,which is about 4,000,,ish human lives less, that did not choose death.Then starting in 2000,ish,,it has approx.,,gone up 2,000 each year,,ie,1786 1 year,2020 the next ,an so on,soo to even it out,,about 2,000 a years,,UNTIL ,,the release of those lovely cdc guidelines,up approx.,,6,000 human live more then in 2015,,Now,,this information would suggest to a logical human being,,that ever since Dr.Government has play Doctor,arresting mostly innocent doctors,,and those doctors forcible dropping there medically ill patients,,leaving them w/no medicine.Dea closing down entire clinics,leaving 10,000 w/no medicine for painful medical conditions,,It would suggest the suicide have increased ever since the government,bullied there way into the field of medicine,,It would also suggest,,years prior,1990’e thru 1999,,w/suicide dropping by 4 % ish,,that Doctors ,left to their own knowledge and thee ability to still use their knowledge learned by over 12 years of schooling,,,Doctors knew better then our government ,how to play Doctors,obviously!
      The invention of a field of Medicine called Pain Management was a step forward in the field of medicine.
      What is happening now,,making doctors guilty of a felony for practicing medicine.Locking up innocent doctors.Denying access to effective medicine to lessen physical pain,,is WRONG,, thus why more people are dieing!!,not less
      Your addiction data,ever ounce of it,,it manifactured,,thus a lie by liars.They changed definition ,that were on the books for 100 years,,Changeing the basic term ,”addiction,” from, taking any medicine for non-medical reason,,to taking a drug,that causes harm,,,,A freaken Aspirin causes harm,should people bee deemed addict to aspirin?NO OF COURSE NOT,, it obvious these definition were changed on purpose,to trump up numbers,,thus ITS ALL 1 BIG LIE,BY LIARS,,
      The klowndy boys have put their prejudicial mentality into our government vias corrupt methods.The got themselves in at important position in our government,to literally change regulation/laws to futher their person agenda/monies,,By deeming the practice of medicine,a felony,for doctors being humane and forcing any medicaly ill human being to forcible suffer in physical pain.The klowndynation wants the days of old back..Where u lock-up cripples in physical pain in huge warehouses again,,Pennhurst all over again,and their pockets full.
      I have to admit,their agenda,propagenda,and corrrutped methodology is working,sadly.They have convince the dea,doj,hhs,fda,etc,,to deem,,treating the medically ill in physical pain,,real doctors,and the effective medicine all criminals now,Making practicing effective humane medical care is now a felony,,great job,,Klowdynation,U have made torture and genocide legal America,,Judgeing from the responds on some site,,they will be thee most hated people in America,a justly so,,For they used the bigotry/hatred of those ,”demon drugs,” opiates as the fuel source for this torture and genocide..
      U could say,their prop-agenda,money making scheme,,was ,”shatterproof,,,and they knew it!
      However,when innocent people are being tortured to death literally.Medically ill people are now dieing agonizing death,,Innocent doctors are being falsely charged,,its time for those who still believe in a humane civilization for America,,its time u say ,,YOU ARE WRONG,,KLONDYN,,U ARE WRONG SHATTERPROOF,,,,when people start dieing for your corrupted cause,,,,,maryw

  • As I have written in other venues, the Christie Commission final report seems to be a profoundly mixed bag. The Commission’s report repeats an outright mythology that will reliably result in deep mis-allocations and misdirection of funds whenever they appear.

    “Over prescription” of opioids to legitimate pain patients didn’t cause the so-called opioid crisis, and further restricting opioid prescriptions to people in agony won’t solve it.

    No less an authority than the US National Institutes on Drug Abuse informs us that the great majority of addicts first begin abusing drugs and alcohol IN THEIR TEENS, often as young as Middle School. People of this age are rarely seen for any pain condition of sufficient severity to justify use of an opioid pain reliever for more than a few days — and in these rare cases the largest category is for dental surgery.

    The best predictors for addiction are status as a young white male, a history of family trauma and prolonged unemployment — NOT prescriptions for chronic pain.

    We frequently hear stories in press of young people who supposedly get “hooked” on opioids after being treated for weeks or months following a sports injury. While such cases do occur, they are not representative of the great bulk of addicts. And basing intervention policies on such unrepresentative cases is outright folly.

    In 2016, Massachusetts attempted to match up a year of death statistics where medical examiners found an opioid among the potential causes, with prescriptions tracked in their State database. As reported in the Boston Globe, fewer than 8% of all opioid-related “victims” had a current prescription. Likewise a 2010 Cochrane Review analyzed multiple published studies of the long term risks and benefits of opioids prescribed to properly screened pain patients who had no previous history of drug use. Among more than 5,000 such patients, fewer than one-half of ONE PERCENT were diagnosed with opioid abuse disorder within one year of their first prescription.

    The real contribution of prescription opioids to our addiction crisis is through diversion and theft, not through direct prescription by doctors. In recent statistics of the CDC itself, the largest number of opioid-related deaths was due to heroin, followed by imported fentanyl from China and Mexico, morphine stolen from hospitals and Methadone diverted from community treatment programs — with “prescription opioids” a distant fifth rank, and possibly half of that category due to drugs sold on the street: a relatively small increment of 7,000 deaths out of 60,000 attributed to drug overdose overall.

    The most effective measures in addressing addiction are already well known. Our government merely doesn’t want to spend the Billions required to be effective. Prevention must begin in Middle School with programs of education that have been evaluated for effectiveness (“Just Say No” was a miserable failure, but some other programs do better). Among people already addicted, Medication Assisted Therapy (Methadone, Naloxone, Bupe) is the most effective measure — but only when accompanied and backed by a multi-faceted community reintegration program. Patients treated in either 28-day detox or Narcotics Anonymous relapse at rates exceeding 90% when patients are discharged back into communities without support.

    Addiction specialists acknowledge that “reintegration” means safe housing, job training, regular and sustained counseling for related mental health problems. Take any of these measures out of the mix, and we will fail utterly — just as the so-called “War on Drugs” did in the 1980s.

    If we want to get real about addiction, then we also need to acknowledge the needs of real people in medical agony, and stop the war against pain patients and their doctors. And we need to spend billions of dollars every year for the foreseeable future as we catch up with the addiction crisis due to street drugs. Anything less is “much ado about nothing”.

  • pssss,,,A SHOUT OUT TO ALLL LAWFUL MEDICAL PROFESSIONAL WHO STILL PRACTICE,REAL MEDICINE,”TO DO NO HARM,” BY NOT DENYING THE MEDICALLY ILL ACCESS TO EFFECTIVE MEDICAL CARE TO LESSEN PHYSICAL PAIN’,,I SAY ALL MEDICAL PROFESSIONALS BECAUSE THERE IS A PROGRAM VIA THE FDA,,ITS CALLED ,”THE BAD ADD PROGRAM,” WHERE ANY ”MEDICAL PROFESSIONAL,” CAN REQUEST A ADD BE PULLED FROM PUBLIC VIEW,,,seeing as though these talking heads want to use MORE tax payers monies to push prohibitions,via the media,,just fyi,,,maryw

  • Well,,it amazes me first off,,How these Governors and others ever got elected to a commission about a subject matter they have never ever been educated on,,Formally or informally..Gee,,maybe its because the persons who will profit from all this opiatephobia are the politician from eachstate,via revoloveing door jail systems!Isn’t there a guy named Howie Klonodyn in the misst of all this?I could be wrong?
    Second,,where the heck is the pain management commission they promised??How can u place any kind of restriction,regulation on a medicine,,if your not legally a doctor?Isn’t that called practicing medicine w/out a license??
    3rd every single piece of data they used is a lie,,,They literal changed definition that were on the book for over 100 years,,to trump up numbers,,Words like addiction,,or drug users have all been changed in thee last 3 years,,,to better fit the reefer madness false data and agenda!!
    Heres the truth folks,,these opiatephobs have lied..All those in a position of government,thus power,,have either lied,,or been lied too..Every piece of data,,uses 12 years to trump up numbers..Every piece of data used for ,”opiates,” is trump up because field drug testing does not distinguish between heroin and lawful drugs,,,soo certain pieces of data simply combine all opiates I under 1 roof,,,TO TRUMP UP NUMBERS,, the reality is the person died of heroin,,not a lawfully prescribed medicine., soo is all opiates fall into 1 category for addiction data,,,,,even though that a outright lie..Again,,to trump up numbers..
    Doctors have literally been terrified ,bullied by our governments abuse of power via the dea,doj,media and govenors.They slander innocent doctors in the media before trail essentially making them guilty in the public eye before they ever get to trail..If the dea goes near a doctors office now a days,,most doctors our telling the dea,,how high do u want me to jump,,instead of fighting back..There dumping patient in rehabs,,thus falsely labeling them addicts for taking their medicine as prescribed,,,out of fear of our own government.However in the process again,,adding to the addiction numbers,,producing another falsehood and screwing that innocent human beings for life….For that person will never see effective physical pain relief ever again,,for a painful medical condition,,ever!
    U got people who know nothing but,”drugs are evil,”and telling the world that all drugs should be deleted,gone..These people are basically decideing who will literally be tortured to death from a painful medical condition,,by falsely believing a LAWFULL MEDICINE lawfully prescribed by a lawful doctors is some how the same as a drug dealers,WRONG!!!,,That’s OUT RIGHT corrupted,WRONG ,,idealogy WHICH was perpetrated by the dea…and those who have the hatred in their souls already for what they believe is a ,”drug,or drug addict,”..Again,since when is the dea,lawful doctors?Like never,,The dea,,Andrew Klonidyn,relatives,prop,,all who had a financial stake in the rehab filler up BUSINESS gang,,all did a beautiful job at using that ”prejudicial hatred,” as their fuel to keep this propaganda going,,,,Hatred is powerful fuel!!
    This committee is a bunch of talking heads.They have no formal education in Pain management, nor the MEDICINES used in effective pain management,,Hell they don’t even have any formal education in addiction,,,,what they do have is power and money,,,and they just used that power and money to abused the publics trust.By using lieful data,propaganda and corruption to make regulations,more,,regulations.How many times are we going to bang our heads against the wall here,,isn’t that the definition of crazy??doing the same thing over and over??Making this whole thing a legal issue,imprisoning these people is not rehabbing them at all,,just paying for another government official salary for a live time with this revolving door?!!
    Laws like,”informed consent,” to protect innocent doctors. are NOT BEING HONORED IN OUR COURT ROOMS.Or laws like u ARE AN ADULT AT THE AGE OF 21,, thus u take responsibilty for your own actions,,No-one put that pill down your throat but 1 person.
    Here what ,”drug courts,” will do,,,They will again give us false data on addiction for 1.Prime example,,here in Wisco,,there was a huge case over at the Tomah V.A.. A adult male of 35 died,,due to the neglect in a psych-ward,,He died,,but the staf thought he was sleeping,,thus no cpr,,nothing,,at the time of death,For no-one even knew the poor man was dead,,,But here is what our headliners were,”candy man,,Tomah V.A,, candy land for opiates,,Doctors fault,,handed out like candy,” unquote,,All done BEFORE trail..The man of 35 years of age had 500 nanoscams of tramadol in his system,,THEE ONLY OPIATE,,THE DOCTORS WAS A SHRINK,,NOT A PAINMANAGEMENT DOCTOR AT ALL,, but,,guess how the 35 year old adult got there,,,He was court order by a judge because he got caught breaking and entering,burglery..Now let me ask all of 1 question,,if u were given thee option of 10 years in prison,,or the option of claiming your an addict,and a mental institution,/counseling for 3,,,which would u pick?!God rest this adult man soul,for he was a Vet,who served our country,,,but this does not mean truth is willfully ignored..I am willing to bet,,if any of the parents of ADULT offspring were told,,,cancer patients,lyme disease M.S,,90 year old gramma,etc are all now being denied access to effective medical care to lessen severe physical pain from medical illness because politicians are useing your son/daughters/fathers/mothers death from them as adults using opiates unlawfully,,to take away medicines from the medically ill,do u think any of them would say GREAT WONDERFUL,,KEEP THE CANCER PATIENT IN PHYSICAL PAIN,,KEEP THE MEDICALLY ILL IN FORCED PHYSICAL PAIN because my adult son/daughter etc,,,died,,from abuseing opiates?!
    This is why truth needs to be exposed,why ,”informed consent,” needs to be honored in our court rooms,,this is why the American Government Politicians,,judges need to start making adults take responsibility for their own behaviours as to what the put in their OWN BODIES,, because now a days,,,that is. not happening,,they are blaming every tim/dick,harry ,doctor,pharma and the mailman,,,,for abusive behaviours in adults,instead of looking in the mirror as to who is responsible for 1ns own body,,This passing the buck ,the lies,the Klonodyns,,have got to be stopped,THEY ARE WRONG,WHEN,INNOCENT PEOPLE NOW A DAYS ARE DIEING LITERALLY,,FOR BEING MEDICALLY ILL,IN PHYSICAL PAIN,,AND THE INNOCENT DOCTORS ARE LOOSING THEIR LIFES WORK,,,BECAUSE AMERICA HAS MADE PRACTICEING MEDICINE A FELONY,,maryw

  • So, part of the new deal is to “ensure patients are adequately educated about the ‘risks, benefits, and alternatives of taking opioids.’ ” That’s a good plan. I think good doctors are already doing that. I just hope that does not become a way of convincing (browbeating) people not to take opioid medications — meds which would make their lives better.

  • https://www.scientificamerican.com/article/people-are-dying-because-of-ignorance-not-because-of-opioids/
    Prescription opioids ARE NOT the cause of the opioid/heroin crisis but all of the responses are to make it more and more difficult for those of us suffering from intractable, chronic pain to receive the one medication that allows us to have some quality of life! There are many resources available that contradict the narrative that Kolodny, PROP and the opioid commission would have people believe. We need to have balanced reporting!

  • Yes, let’s address everything but paying for treatment other than drugs. Physical therapy, spinal alignment, meditation, tai chi and yoga, acupuncture, massage, diet, clean water, exercise…but no PROFIT in these treatments, so insurance will not pay. Instead you’re going to cut off medication for people in real, debilitating pain that causes physical and chemical changes to the brain in response to the stress of chronic pain, and other disabling conditions. Because there’s no PROFIT in helping these people, but plenty of profit in drugs, law enforcement, and privatized prisons. Educated, experienced, knowledgeable medical professionals and many lay persons know this, and are cringing at these tactics designed to solve nothing. Unfortunately, the fearmongering about drugs and crime and “crisis” that Trump conveniently doesn’t have to fund by naming it a “public health emergency” instead of a national emergency works on the majority of the ignorant who’ve been carefully manipulated to accept and cling to the path they’re driven down. Now THAT’S sad.

  • According to official statistics, 65,000 people died from drug overdoses in the U.S. in 2016. An estimated 300,000 deaths per year are due to the obesity epidemic.

    Gov. Christie should focus on eating less donuts before making recommendations about the health of others.

    • And, preventable medical error is the 3rd leading cause of death according to the CDC, with over 250,000 deaths last year, about 5 times the number of deaths due to opioids, typically heroin laced with fentanyl. But we sure don’t hear anything about that crisis do we.

    • My body IS 1 BIG MEDICAL ERROR,, they hate even acknowledging they made/make terrible mistakes that hurt people,FOR LIFE..Again,,these talking heads have absolutely no education/experience in the politics of doctors/hospitals.People get injured for life by medical errors.Many times some Doc will cover that up,hide records,I have even had a entire x-ray disappear from a collapsed left lung,,If it wasn’t for the chest tube scar,,I was being called a liar,I hate being called a liar,when I have NEVER LIED in my life,,no reason too,,Point again,,,these politicians know nothing about what they spoke of at all,,,,,maryw

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