- Prescriber Training: First, to help ensure that health care professionals who prescribe opioids are properly trained in opioid prescribing and to establish the Federal Government as a model, the Presidential Memorandum requires Federal Departments and Agencies to provide training on the prescribing of these medications to Federal health care professionals who prescribe controlled substances as part of their Federal responsibilities.
- Improving Access to Treatment: Second, to improve access to treatment for prescription drug abuse and heroin use, the Presidential Memorandum directs Federal Departments and Agencies that directly provide, contract to provide, reimburse for, or otherwise facilitate access to health benefits, to conduct a review to identify barriers to medication-assisted treatment for opioid use disorders and develop action plans to address these barriers.
More Americans now die every year from drug overdoses than they do in motor vehicle crashes and the majority of those overdoses involve prescription medications. Health care providers wrote 259 million prescriptions for opioid pain medications in 2012 – enough for every American adult to have a bottle of pills. Opioids are a class of prescription pain medications that includes hydrocodone, oxycodone, morphine, and methadone. Heroin belongs to the same class of drugs, and four in five heroin users started out by misusing prescription opioid pain medications.
In 2010, the President released his first National Drug Control Strategy, which emphasized the need for action to address opioid use disorders and overdose, while ensuring that individuals with pain receive safe, effective treatment. Since then, the Administration has supported and expanded community-based efforts to prevent drug use, pursue ‘smart on crime’ approaches to drug enforcement, improve prescribing practices for pain medication, increase access to treatment, work to reduce overdose deaths, and support the millions of Americans in recovery.
The most recent data show that the rate of overdoses involving prescription pain medication is leveling off, although it remains at an unacceptably high level. But the dramatic rise in heroin-related overdoses – which nearly doubled between 2011 and 2013 – shows the opioid crisis is far from over.
State, Local and Private Sector actions announced today include:
- More than 40 provider groups – including physicians, dentists, advanced practice registered nurses, physician assistants, physical therapists and educators — committed to:
- Have more than 540,000 health care providers complete opioid prescriber training in the next two years;
- Double the number of physicians certified to prescribe buprenorphine for opioid use disorder treatment, from 30,000 to 60,000 over the next three years;
- Double the number of providers that prescribe naloxone–a drug that can reverse an opioid overdose;
- Double the number of health care providers registered with their State Prescription Drug Monitoring Programs in the next two years; and
- Reach more than 4 million health care providers with awareness messaging on opioid abuse, appropriate prescribing practices, and actions providers can take to be a part of the solution in the next two years.
Groups include the American Medical Association, American Osteopathic Association, American Academy of Family Physicians, American College of Emergency Physicians, American Academy of Hospice and Palliative Medicine, American Congress of Obstetricians and Gynecologists, American Academy of Pediatricians, American Society of Anesthesiologists, American Society of Addiction Medicine, American College of Osteopathic Internists, American Pain Society, American Academy of Addiction Psychiatry, American College of Physicians, American College of Osteopathic Emergency Physicians, American Academy of Pain Medicine, Interstate Postgraduate Medical Association, Physician’s Institute, American College of Osteopathic Surgeons, American College of Osteopathic Family Physicians, American Osteopathic Academy of Addiction Medicine, American Medical Student Association, American Medical Women’s Association,Michigan Osteopathic Association, Ohio Osteopathic Association, Massachusetts Medical Society, Washington Osteopathic Medical Association, New Mexico Medical Society, California Academy of Family Physicians, Conjoint Committee on Continuing Education, Collaboration for REMS Education, American Nurses Association, American Association of Nurse Practitioners, American Association of Nurse Anesthetists, Association of Women’s Health, Obstetric and Neonatal Nurses, American Psychiatric Nurses Association, American Association of Colleges of Nursing, National Association of Clinical Nurse Specialists, Nurse Practitioner Healthcare Foundation, American Academy of Physician Assistants, Physician Assistant Education Association, American Dental Association, American Physical Therapy Association, Association of American Medical Colleges, American Public Health Association, and Medscape.
- CVS Health will allow CVS/pharmacy to dispense naloxone without patients needing to present an individual prescription pursuant to a standing order from a physician or collaborative practice agreement in an additional 20 states in 2016 and will launch a new drug abuse prevention program called Pharmacists Teach, where its pharmacists will make 2,500 presentations in high school health classes. Rite Aid will train 6,000 pharmacists on naloxone use over the next 12 months, and expand their naloxone dispensing program to additional states. The National Association of Chain Drug Stores will continue to educate their 125 chain member companies (40,000 pharmacies with 175,000 pharmacists) about opioid overdose and naloxone. The National Community Pharmacists Association, representing 23,000 pharmacies with over 62,000 pharmacists, will be distributing inserts to community pharmacists that highlight safe drug disposal and naloxone. The American Pharmacists Association,with an outreach capability to more than 250,000 individuals, will educate pharmacists, student pharmacists, and stakeholders through a new Resource Center on opioid use, misuse, and abuse. The American Society of Health-System Pharmacists will provide training and resources to 40,000 pharmacists, student pharmacists and pharmacy technicians. The National Association of Boards of Pharmacy will enhance access to prescription drug monitoring program data to thousands more physicians and pharmacists in Arizona, Delaware, Kentucky, and North Dakota in 2016.
- The Fraternal Order of Police will provide their 330,000 members with an Opioid Overdose Resuscitation card to help identify and respond to overdoses. They will also educate thousands of their members through in-person and webinar overdose prevention trainings over the next year. TheInternational Association of Chiefs of Police will host several educational sessions on the role of law enforcement in overdose prevention at its annual conference and will also hold an overdose prevention training webinar for its members.
- The National Association of Counties, National League of Cities, and United States Conference of Mayors, in conjunction with U.S. Communities Purchasing Alliance and Premier, Inc., will secure industry-leading discounts for tens of thousands of public agencies on naloxone and medications for treatment through their purchasing program that pools the purchasing power of state and local governments.
- To support the Partnership for Drug-Free Kids’ media campaign over the next year to increase the education and awareness of young people and their parents about the risks of prescription drug misuse, CBS Television Network, Turner Broadcasting, ABC owned and operated TV Stations, The New York Times, Google, Café Mom, and Meredith are committing more than $20 million in donated airtime and advertising space, and additional commitments are expected. The National Basketball Association and Major League Baseball will also run public service announcements across their respective media assets. The Partnership is also releasing an online toolkit to help local governments, law enforcement, and other community jurisdictions implement local drug disposal programs.
- Because prescription opioid misuse is a growing concern in high school and college athletics, The National Collegiate Athletic Association will educate more than 30,000 student-athletes about the dangers of prescription drug misuse, publish best practices to support student-athlete behavioral health, and sponsor the third Step UP! Bystander Intervention conference to equip educators to assist their students and student-athletes in intervening with peers on a host of behavioral concerns, including prescription drug misuse. The National Association of High School Coaches will launch a drug prevention awareness campaign that will be shared with 320,000 head high school coaches and approximately 60,000 high school administrators. The American College of Sports Medicine will mobilize more than 500,000 sports medicine professionals in support of their“Better Move Campaign” to reduce the overuse and overdose of prescription pain medications. The National Athletic Trainers’ Association will share educational materials on opioid misuse prevention to 40,000 athletic trainers. The National Interscholastic Athletic Administrators Association will educate its membership of over 9,500 secondary school athletic administrators about substance use and its relationship to health and performance through its professional development program.
- The National PTA, which has more than four million members, will distribute prescription drug misuse awareness and educational materials to its members and promote them through its digital assets.
- Governors and local governments will be taking new actions to reduce opioid misuse and overdose throughout the next year. TheNational Association of Counties will mobilize more county leaders to implement smart strategies to reduce opioid misuse and overdose through their Safe and Secure Counties Initiative. The National Governors Association will launch a Developing Effective State Responses to the Heroin Epidemic project to help states identify and implement effective strategies for reducing heroin use and overdose. The United States Conference of Mayors, through its new Substance Abuse, Prevention, and Recovery Services Task Force, will identify effective prevention, intervention, treatment, recovery, and support services to promote to city mayors nationwide.
- The Harm Reduction Coalition will increase the number of naloxone doses provided through its network of partners from 130,000 in 2013 to 400,000 in 2016 and will work with 10 state prisons to provide training and naloxone kits to 4,000 pre-release inmates and their family members in 2016. They will also convene a national summit on how syringe services programs are integrating broader prevention, counseling, care and treatment initiatives in response to the opioid epidemic.
- The Elks National Drug Awareness Program will purchase and install at least 500 prescription drug disposal boxes in communities where heroin use and prescription drug abuse are most prevalent by the end of 2016.
- The Community Anti-Drug Coalitions of America will train 2,000 youth leaders across the country about the dangers of prescription drug abuse; train 12,000 youth and adult leaders on effective prescription drug abuse prevention strategies; and hold 100 community forums to mobilize youth and adult leaders on this issue in 2016.
- The Dr. Oz Show will launch a campaign leading up to a National Night of Conversation event on November 19 to encourage parents to talk with their children about prescription pain medications, heroin, and other drugs. Dr. Oz will promote this prevention initiative to millions of Americans through his show, other media appearances, and his nationally syndicated newspaper column.
- The Blue Cross Blue Shield Association is launching a national opioid use awareness campaign to help communities find local solutions for prevention and treatment.
- The American Physical Therapy Association will reach more than 2.5 million members of the public and more than 100,000 of its members through awareness campaigns about the benefits of physical therapy as a potential alternative to prescription pain medications. The National Association of Social Workers will expand training for its 132,000 members on treatment of substance use disorders including opioid misuse, and will train school social workers to partner with parent and school organizations on prevention efforts. The American Public Health Association will provide continuing education credit training on prescription drug overdose to more than 1,500 health providers and distribute prescription drug misuse awareness materials to over 300,000 public health professionals.
- The American Association of Colleges of Nursing, theAssociation of American Medical Colleges, and the Physician Assistant Education Association will share professional guidance and best practices to better educate the next generation of health care workers on opioid misuse and substance use disorders.
- WebMD and Medscape are committed to increasing awareness of opioid issues and informing and educating consumer and professional audiences. In December, WebMD and Medscape will produce a report on consumer and health care professionals’ awareness of issues surrounding opioid use. The report will be based on findings of a joint survey of consumers and health care professionals and explore issues ranging from prescribing practices and guidelines to the use and disposal of the drugs, as well as general levels of awareness around their misuse.
Additional Federal actions announced today include:
- The Drug Enforcement Administration announced that it will continue its National Prescription Drug Take-Back Day program events in the spring and fall of 2016. As the President highlighted in a recent Weekly Address, Take-Back Day aims to provide a safe, convenient, and responsible means of disposing of unused prescription drugs, while educating the public about the dangers of misusing medications.
- The Department of Health and Human Services (HHS) will undertake a review of how pain management is evaluated by patient satisfaction surveys used by hospitals and other health care providers, including review of how the questions these surveys use to assess pain management may relate to pain management practices and opioid prescribing.
- The Centers for Disease Control and Prevention (CDC) will invest $8.5 million on the development of tools and resources to help inform prescribers about appropriate opioid prescribing; track data on prescribing trends; research, develop, and evaluate clinical quality improvement measures and programs on opioid prescribing; and improve public understanding of the risks and benefits of opioid use.
- HHS also launched HHS.gov/opioids as a one-stop federal resource with tools and information for families, health care providers, law enforcement, and other stakeholders on prescription drug abuse and heroin use prevention, treatment, and response.
- U.S. Surgeon General Vivek Murthy is developing an education campaign for doctors, dentists and other health care professionals who prescribe opioid pain medications. Earlier this month, Dr. Murthy also announced that work has begun on the first-ever Surgeon General’s Report on substance use, addiction and health scheduled for publication in 2016.
- Centers for Medicare and Medicaid Services (CMS) will release an Information Bulletin to States by the end of the year on steps States can take through their Medicaid preferred drug lists (PDLs) and other utilization management mechanisms to reduce the risk of overdose. This includes a recommendation that they consider removing methadone from their PDLs for pain management. The Centers for Disease Control and Prevention has found that the use of methadone in pain treatment is associated with a disproportionately high number of overdose deaths compared to other opioid pain relievers.
- This fall, CMS is testing three new Medicare prescription drug plan measures designed to identify potential opioid overutilization, with the goal of proposing publicly reportable measures for Part D drug plans next year. These measures are based on the work of the Pharmacy Quality Alliance.
- The Department of Veterans Affairs will lead a research initiative to evaluate non-opioid alternative approaches to pain management. The Department of Defense (DoD) and VA are developing a standardized pain management curriculum for widespread use in education and training programs.
- The Bureau of Indian Affairs (BIA) and the Indian Health Service will provide BIA police officers and investigators the overdose reversal drug naloxone and training on its use. In 2016, the BIA, through the United States Indian Police Academy, will provide training to all BIA and tribal police officer cadets in recognizing opioid use disorders and overdose symptoms.
- The White House will host a Champions of Change event this spring to highlight individuals in communities across the country who are leading the fight to respond to prescription drug abuse and heroin use.
Today’s actions build on the Administration’s commitment to confronting this epidemic:
In 2010, the President released his first National Drug Control Strategy, emphasizing the need for action to address opioid use disorders and overdose, while ensuring that individuals with pain receive safe, effective treatment. The next year, the White House released its national Prescription Drug Abuse Prevention Plan to outline our goals for addressing prescription drug abuse and overdose.
The President’s Fiscal Year 2016 budget includes $133 million in new investments aimed at addressing the opioid epidemic, including expanding state-level prescription drug overdose prevention strategies, medication-assisted treatment programs, and access to the overdose-reversal drug naloxone.
Examples of additional actions by the Administration to address the opioid epidemic include:
Community Prevention and Overdose Response
- In 2015, the CDC launched the Prescription Drug Overdose: Prevention for States Program, which provided $20 million to states to support strategies to improve prescribing practices and prevent opioid overdose deaths.
- Through the National Take Back Days to remove unused prescription drugs from the community, the Drug Enforcement Administration (DEA) has collected more than 5.5 million pounds of medication and introduced several new ways to dispose of unused prescription drugs – including pre-paid return-mail packages. DEA also finalized a new rule making it easier for communities to establish ongoing drug take-back programs.
- In 2012, the Department of Veterans Affairs established an Opioid Safety Initiative to enhance safe and effective pain care for veterans. VA medical centers have filled more than 6,500 naloxone kit prescriptions, and VA’s efforts to make opioid overdose kits available has resulted in at least 100 lives saved.
- With support from the Department of Justice (DOJ) and other funders, 49 states have established Prescription Drug Monitoring Programs to help prescribers identify potential opioid misuse issues.
- In 2015, HHS announced a targeted initiative to combat opioid related overdose, death, and dependence focused on increasing prescriber training, increasing the use of the overdose reversal drug naloxone, and expanding the use of medication-assisted treatment.
- The federal government is expanding access to prescription drug monitoring program data throughout federal agencies. DoD’s Pharmacy Data Transaction Service automatically screens all new medication orders against a patient’s computerized medication history and permits DoD to monitor for concerning drug usage patterns. DoD’s Polypharmacy Medication Analysis Reporting is being used to identify high risk active duty service members based on their medication use and emergency department encounters. The Indian Health Service has successfully piloted integrating this data into their electronic systems, and a pilot to integrate data into the workflow of physicians in the DoD health system is slated to launch in 2016.
- The DOJ Bureau of Justice Assistance released a Law Enforcement Naloxone Toolkit to support law enforcement agencies in establishing naloxone programs. The toolkit has been downloaded more than 2,200 times in the last year.
- DOD is ensuring that opioid overdose reversal kits and training are available to every first responder on military bases or other areas under its control.
- The Office of National Drug Control Policy supports local Drug Free Communities coalitions to reduce youth substance use through evidence-based prevention. In recent years, hundreds of these coalitions have specifically focused on prescription drug misuse issues in their areas.
- Thanks to the Affordable Care Act, substance use disorder and mental health services are essential health benefits that are required to be covered by health plans in the Health Insurance Marketplace.
- New rules finalized by this Administration ensure that covered mental health and substance use disorder benefits are comparable to medical and surgical benefits.
- HHS is investing up to $100 million in Affordable Care Act funding to expand substance use disorder treatment, with a focus on medication-assisted treatment for opioid use disorders, in community health centers across the country.
- HHS Secretary Burwell announced that the Department will engage in rulemaking related to the prescribing of buprenorphine-containing products approved by the FDA for treatment of opioid dependence to expand access to medication-assisted treatment for opioid use disorders. HHS will take a strategic approach in order to minimize diversion and ensure evidence-based treatment.
- The CDC has been working over the last year with clinical experts and other stakeholders to develop new, peer-reviewed guidelines on prescribing opioids for chronic pain outside end of life settings to help improve the way opioids are prescribed and ensure patients have access to safer, more effective chronic pain treatment, while reducing opioid misuse and overdose.
- HHS recently awarded $11 million in new grants to States to support medication-assisted treatment and $1.8 million to help rural communities purchase naloxone and train first responders in its use.
Enforcement and Supply Reduction
- The White House Office of National Drug Control Policy’s High Intensity Drug Trafficking Areas program is funding an unprecedented network of public health and law enforcement partnerships to address the heroin threat across 15 states.
- In October of 2015, DOJ’s Office of Community Oriented Policing Services (COPS Office) awarded $6 million through the Anti-Heroin Task Force Program, which is designed to advance public safety by providing funds to investigate illicit activities related to the distribution of heroin or unlawful distribution of prescriptive opioids, or unlawful heroin and prescription opioid traffickers through statewide collaboration.
- DOJ’s enforcement efforts include targeting the illegal opioid supply chain, thwarting doctor-shopping attempts, and disrupting so-called “pill mills.”
- DOJ has cracked down on those who use the Internet to buy and sell controlled substances.
- DEA agents and investigators are integrating with other federal, state, and local law enforcement officers in 66 Tactical Diversion Squads stationed across 41 states, Puerto Rico, and the District of Columbia. Outcomes of this effort include the largest pharmaceutical-related takedown in the DEA’s history in an operation that resulted in 280 arrests.
- Since 2007, through the Merida Initiative, the Department of State has been working with the Government of Mexico to help build the capacity of Mexico’s law enforcement and justice sector institutions to disrupt drug trafficking organizations and to stop the flow of illicit drugs including heroin from Mexico to the United States.
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