Policy At A Glance: July 2018 INSTITUTE FOR HEALTH POLICY AND LEADERSHIP

10/26/17 President Trump declares the opioid epidemic a public health emergency

4/24/18 Senate Health, Education, Labor and Pensions Committee approves the Opioid Crisis Response Act of 2018 (S. 2680)

2/2/16 President Obama allots $1 billion as opioid crisis grant to states

5/17/18 House Energy and Commerce Committee advances H.R. 6 to the House

Timeline

The Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for

Patients and Communities Act (H.R. 6)

What are opioids? Opioids are effective short-term pain relievers but they also create a feeling of euphoria that often leads to their misuse and abuse. According to the National Institute on Drug Abuse, opioids are found naturally in the opium poppy plant and include2:

• Pharmaceutical painkillers such as oxycodone (OxyContin, Percocet), hydrocodone (Vicodin), codeine, morphine (Kadian, Avinza), and oxymorphone (Opana)

• Illegal drugs such as heroin (one of the most dangerous form of opioid and never used as medicine in the United States)3

• Synthetic drugs such as fentanyl

Fentanyl accounts for 45.9 percent of the drug overdose deaths in the United States while 40.4 percent involve prescription opioids and 36.6 percent are attributed to heroin (some deaths involved multiple drugs).4 According to the Centers for Disease Control and Prevention (CDC), opioid overdoses killed 64,000 people in 2016, the highest number of any year on record.5

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leadership development. Our goal is to improve the health of our communities by building on our strong heritage of health promotion and disease prevention.

To learn more, visit us at www.IHPL.llu.edu

The House of Representatives recently passed “the biggest effort Congress has ever undertaken.”1 H.R. 6, a package of 57 bills, addresses the nation’s growing addiction to prescription painkillers.

6/22/18 House passes H.R. 6 with bipartisan support (396:14)

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INSTITUTE FOR HEALTH POLICY AND LEADERSHIP July 2018

What is the SUPPORT for Patients and Communities Act of 2018 (H.R. 6)? H.R. 6 combines 57 bills already approved individually by the House. Below are notable measures included in H.R. 6:

• H.R. 5009 - “Jessie’s Law.” This bill is named after Jessie Grubb, a 30-year old recovering heroin addict. Jessie died from a fatal drug overdose following a hip surgery when her discharging physician prescribed 50 pills of oxycodone. H.R. 5009 ensures that medical providers have access to a patient’s prior addiction history before making care and treatment decisions.

• H.R. 3692 – Addiction Treatment Access Improvement Act of 2017. This bill provides clinical nurse specialists, certified registered nurse anesthetists, and certified nurse midwives the ability to prescribe buprenorphine (a narcotic used to treat opioid addiction) and increases the number of patients a provider can treat with buprenorphine. H.R. 3692 also gives physician assistants and nurse practitioners permanent buprenorphine prescribing authority.

• H.R. 5102 – Substance Use Disorder Workforce Loan Repayment Act of 2018. This bill establishes a loan repayment program for addiction care providers working in a “mental health professional shortage area or a county where the drug overdose death rate is higher than the national average.”6

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America’s Opioid Epidemic According to the Centers for Disease Control and Prevention, opioid painkillers are the most commonly prescribed class of medications in the United States.7 In 2014, 245 million opioid prescriptions were dispensed and 11.5 million people misused prescription opioids.1,7 Opioid overdoses and deaths are common due to our reliance on opioid medication for pain relief coupled with opioid’s addictive nature. In fact, overdose deaths from opioids have increased by more than five times since 1999.8 The opioid crisis has also cost the United States economy more than $1 trillion from 2001 to 2017 and is expected to cost an additional $500 billion by 2020.9

In 2016 alone, 116 Americans died every day from opioid-

related drug overdoses.2

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INSTITUTE FOR HEALTH POLICY AND LEADERSHIP July 2018

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• H.R. 5808 – Medicaid Pharmaceutical Home Act of 2018. This bill requires all state Medicaid programs to identify patients who are at risk for substance use disorder and assign them to a pharmaceutical home program.

• H.R. 5798 – Opioid Screening and Chronic Pain Management Alternatives for Seniors Act. This bill adds opioid use disorder screenings to the Welcome to Medicare initial examination.

• H.R. 3528 – Every Prescription Conveyed Securely Act. This bill requires electronic prescriptions for Medicare Part D opioids to better track opioid prescriptions.

• H.R. 5806 – 21st Century Tools for Pain and Addiction Treatment Act. This bill directs the Food and Drug Administration to update its existing approval process to speed up the development of new non-addictive medications for pain and addiction.

• H.R. 3192 – The CHIP Mental Health Parity Act. This bill requires the state Children’s Health Insurance Program (CHIP) to cover mental health benefits including substance use disorder services for pregnant women and children.

• H.R. 5788 – The Synthetics Trafficking and Overdose Prevention (STOP) Act of 2018. This bill obtains advance electronic data on international mail shipments to prevent the illegal entry of opioids via the U.S. Postal Service.

• H.R. 3331. This bill enables testing of new incentive payments that encourage behavioral health providers to use electronic health records.

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• H.R. 5797 – Individuals in Medicaid Deserve Care that is Appropriate and Responsible in its Execution Act (or IMD Care Act). Institutions for Mental Diseases (IMD) are inpatient mental health facilities with more than 16 beds. Currently, Medicaid does not reimburse mental health or substance use treatments received in an IMD for individuals under the age of 65. This is known as the “IMD exclusion,” which experts identify as a barrier to treating substance use disorder patients, whose detoxification and rehabilitation often require long stays in inpatient facilities.10 H.R 577 temporarily waives IMD exclusions for five years, allowing states to receive Medicaid payments for services provided in an IMD.

Supporters of H.R. 6 believe that this is a good step forward in addressing the national opioid crisis while critics argue that the bill fails to address critical components such as overlooking methamphetamine and cocaine; not expanding syringe exchange services or supervised injection sites; not establishing a permanent funding source for addiction treatment; and not integrating addiction treatment into primary care. H.R. 6 is now headed to the Senate for a vote there.

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INSTITUTE FOR HEALTH POLICY AND LEADERSHIP July 2018

What is the Senate doing to address the opioid epidemic?

In April, the Senate Health, Education, Labor & Pensions committee approved a bipartisan bill, the Opioid Crisis Response Act of 2018 (S. 2680). S. 2680 combines 40 different proposals from 38 senators from both parties and include plans to11:

• Research and develop non-addictive painkillers • Improve detection and seizure of illegal opioids • Package opioids for a set treatment duration (“blister pack”

for 3 or 7-day supply) to limit overprescribing

On June 12th, the Senate Finance Committee also approved the Helping to End Addiction and Lessen (HEAL) Substance Use Disorders Act of 2018 (S. 3120) to improve “education, prevention, management, and treatment options for pain and addiction” suffered by Medicare and Medicaid patients.12 These Senate proposals and H.R. 6 will most likely be merged before heading to President Trump for his signature.

References

1. https://energycommerce.house.gov/opioids-spotlight/ 2. https://www.drugabuse.gov/drugs-abuse/opioids 3. https://www.drugabuse.gov/publications/drugfacts/prescription-opioids 4. https://www.drugabuse.gov/news-events/news-releases/2018/05/nearly-

half-opioid-related-overdose-deaths-involve-fentanyl 5. https://www.cdc.gov/nchs/products/databriefs/db294.htm 6. https://www.congress.gov/bill/115th-congress/house-bill/5102 7. Volkow, N.D. and McLellan, A.T. Opioid Abuse in Chronic Pain –

Misconceptions and Mitigation Strategies. New England Journal of Medicine, 374(13): 1253-1263.

8. https://www.cdc.gov/drugoverdose/data/index.html 9. https://altarum.org/about/news-and-events/economic-toll-of-opioid-crisis-

in-u-s-exceeded-1-trillion-since-2001 10. https://www.macpac.gov/wp-content/uploads/2016/03/The-Medicaid-

Institution-for-Mental-Diseases-IMD-Exclusion.pdf 11. https://www.help.senate.gov/chair/newsroom/press/alexander-senate-

health-committee-unanimously-passes-bipartisan-bill-to-take-next-step-in-helping-states-fight-opioid-crisis

12. https://www.aha.org/news/headline/2018-06-13-senate-finance-committee-advances-opioid-legislation

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Questions? Please contact Helen Jung, DrPH, MPH. Senior Health Policy Analyst at the Institute for Health Policy & Leadership (helenjung@llu.edu)

Physician prescriptions are a major source of diverted and

improperly used opioids.7