Upgrading opioid-treatment resources remains unfinished White House business

Although the opioid crisis continues to kill more than 100 Americans daily, the Trump Administration remains in a mode of paying lip service to addressing the crisis, apart from the wrangling over the recently passed 2018 federal budget, and the first go at a 2019 budget. While there was roughly $1 billion (total) added to the 2017 and 2018 budgets for opioid treatment and research, that money came out of the 21st Century Cures Act, passed in the waning weeks of the Obama Administration. Congress added $3 billion to the just-passed budget for this year, and there is talk of adding $7 billion to next year’s budget, but the while the 2018 funding (to HHS) is supposed to support a variety of efforts (including treatment), it’s not clear what is going to happen. The Christie Commission on Combating Drug Addiction, announced with much fanfare last fall, is all but forgotten. The Office of National Drug Control Policy (ONDCP)—nominally, the location of the national “drug czar”—remains leaderless (and, amazingly, the highest-raking officer in that group for the moment is a 24-year-old campaign worker).

The Interdict Act was passed in January, putting $9 million in the hands of the Dept. of Homeland Security to step up monitoring of border trade to intercept illegal opioid shipments; that measure tries to address opioid supply (specifically, fentanyl).

Funding addiction treatment is but a minor item in the continuing wrangling over healthcare funding, with the Trump Administration proposing significant cuts in Medicaid in 2019, and reducing the tax payments that supported Obamacare over the past year (which will affect insurance premiums for consumers). A proposed near-elimination of ONDCP funding—with the monies going over to DEA and Homeland Security—is not likely to pass Congress, according to press reports.

In late February, the American Medical Assn. sent a letter to the Senate Finance Committee, seeking to expand coverage of medication-assisted treatment (MAT) for drug addiction, eliminating the requirement of prior authorization for MAT, and reducing the regulatory requirements for physicians prescribing burprenorphine (a MAT drug; others are naltrexone and methadone). Only 10% of drug addicts currently have access to MAT (most treatment centers remain focused on abstinence).

Meanwhile, the Healthcare Distribution Alliance is still trying to make the suspicious-order monitoring (SOM) system work better. On Feb. 22, it wrote a letter to DEA suggesting that a “universal” SOM database be set up, such that DEA information could be shared with state authorities, essentially closing a loop between industry reports to DEA and to state authorities; also that DEA standardize how industry reports SOM data to the agency. (HDA has long complained that SOM analysis would work better if DEA consolidated SOM data, which can consist of multiple distributors shipping orders to the same pharmacy; DEA announced this capability in early February.) In the public eye, SOM is a black eye for the distribution industry following a series of Washington Post reports last fall. Those reports blamed passage of the 2016 Ensuring Public Access and Effective Drug Enforcement Act—a law supported by HDA—for hamstringing DEA’s ability to penalize distributors for poor SOM practices. Although DEA still has enforcement power (and although the benefit of attempting to control drug access by going after distributors is debatable), SOM practices remain a murky industry practice. HDA says it is awaiting a DEA action on a new proposed rule, expected in March.