5 Things Trump Could Do Right Now to Ease the Opioid Crisis
ith an estimated 142 Americans now dying every day from drug overdoses, the Trump administration is poised to declare the opioid crisis a national emergency.
Two-thirds of those deaths are accounted for by prescription painkillers such as Percocet and OxyContin and the street drugs heroin and fentanyl. The number of opioid pills prescribed in the US has quadrupled since 1999, as has the number of opioid overdoses, the interim report of the presidential commission on combating drug addiction and the opioid crisis noted in July. Yet “there has not been an overall change in the amount of pain Americans have reported in that period”, the commission wrote, and far too few people receive any treatment for their addiction.
Here are five things the Trump administration could do today to ease America’s opioid crisis.
1. Equip all police officers in the US with naloxoneThe antidote drug reverses the effect of an opioid overdose and saves lives. Mandating that law enforcement everywhere carry it should be the main push in a dramatic expansion of access to the medication, experts say. Pharmacists should also be authorized to dispense naloxone – often branded as Narcan or Evzio – to at-risk patients and concerned family and friends. And it should be prescribed alongside high-risk opioids. Experts want to encourage all states to have "good Samaritan" laws that protect those seeking naloxone for overdoses from prosecution. By declaring a national emergency – as the opioids report recommended – the government in many circumstances can force down the cost of naloxone, which is often grossly overpriced.
2. Expand medication-assisted treatment (MAT)Turning to methadone and buprenorphine as controlled medications for those trying to quit heroin or narcotic painkillers is controversial. They are regarded suspiciously because they are opioids, too, though they are designed to quell cravings and avoid dangerous highs. But the commission says MAT methods“reduce overdose deaths, retain persons in treatment, decrease use of heroin, reduce relapse, and prevent spread of infectious disease”.
Only around 10% of conventional drug treatment facilities in the US provide MAT for opioid use disorder. The federal government can provide incentives and funding for expanded use and request that states provide MAT under Medicare and Medicaid, the public heath programs for the elderly and the poor. Counseling and behavioral therapies should go hand in hand, experts say.
3. Mandate fresh training on opioids for doctors and dentistsFederal agencies report that four out of five new heroin users begin by abusing prescription painkillers. The Controlled Substance Act can be amended to require that all clinicians licensed to write prescriptions take a course in addiction prevention and the proper treatment of pain.
Doctors and dentists require re-training in the dangers of over-prescribing opioids, such as the brand name pills Percocet and OxyContin, expert say. Programs for practitioners and medical students should cover the efficacy of different medications in different pain situations, such as acute post-surgical pain versus chronic pain, to make them less susceptible to the marketing and lobbying power of the pharmaceutical companies.
4. Allow Medicaid to be used for in-patient addiction treatment facilitiesDeclaring the opioid crisis a national emergency would allow the waiving of rules that currently force states to pay for low-income people being treated for drug-dependency in non-hospital facilities with more than 16 beds. The Social Security Act prohibits federal reimbursement for mental health patients, including those suffering from addictions and in opioid withdrawal, in such facilities, even when they’re eligible for Medicaid for other healthcare needs.
The president’s special commission noted that the governors of every state, treatment providers, advocacy groups and families reported that many are being deprived of in-patient services for severe dependency because of the restriction on Medicaid. Repealing that would not require legislation and “is the single fastest way to increase treatment availability across the nation,” the commission said.
5. Stop health insurers discriminating against addictsVigorously enforce the 2008 law designed to force insurance companies to cover mental health conditions, including drug dependency, with the same benefits as physical health problems. Failing to provide equality of coverage for treatment and medication is already illegal under the Mental Health Parity and Addiction Equity Act.
But it’s a persistent problem and can leave patients in danger when denied certain treatments their doctor recommends or facing limits to benefits that would not be imposed in the case of a surgery, for example. The president should direct the Department of Labor to use all its current powers fully, in conjunction with state agencies, to monitor insurance companies and crack down on violators.
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