White House opioid commission to Trump 'Declare a national emergency' on drug overdoses

  1. A preliminary report was issued earlier this week by the President's Commission of Combatting Drug Addiction and the Opioid Crisis stating that its "first and most urgent recommendation" is for the president to "declare a national emergency under either the Public Health Service Act of the Stafford Act".

    “With approximately 142 Americans dying every day,” the report notes, “America is enduring a death toll equal to September 11th every three weeks.”
    This is an amazing statistic!! Something needs to be done. What do you think of the recommendation?

    For the rest of this story, go to White House opioid commission to Trump 'Declare a national emergency' on drug overdoses
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  2. 12 Comments

  3. by   Lil Nel
    Well, I certainly don't disagree with the findings of the Commission. But where I am not completely comfortable with their recommendations is the use Suboxone.

    In my opinion, it is simply trading one drug for another, and what is the point of that? Also, Suboxone is widely abused by addicts. So, it may be prescribed for a good purpose, only to be abused.

    And I am curious about increased funding for recovery care under Medicaid. I support the idea. But this administration tried very hard recently to CUT millions off from Medicaid. So, how will this work?

    It will cost money to fight opioid abuse. And I don't see this administration willing to spend what it will take. We will see.
  4. by   nursej22
    I have to disagree with you, Nel about suboxone treatment. Evidence-based, effective opioid addiction treatment includes both medication and behavior health treatment. Treatment with suboxone greatly decreases the chance of overdose, and spread of Hepatitis C and HIV. It keeps patients alive long enough to undergo counseling. There is little evidence to support complete abstinence from all opioids as an effective treatment.

    Yes, there is an abuse potential for suboxone, but is is much less than heroin because of the receptors it works on.
  5. by   MunoRN
    Declaring a State of Emergency would at least be symbolic, but so far there hasn't really been a problem with a lack of talk and symbolism, it's been following that up with actual actions and policy.

    While campaigning and during the transition, Trump often promised more funding and more action for opioid treatment, but in office he has actually proposed drastic cuts to opioid addiction treatment and prevention. This includes backing cuts to medicaid funded treatment as well as cutting the programs that help prevent and treat opioid addiction.

    It doesn't help that his head of the FDA, Scott Gottlieb, has been associated with the American Pain Foundation, which was a sham "practice organization" which turned out to be a combined effort of multiple opioid manufacturers that had the purpose of expanding opioid use.
  6. by   MunoRN
    Quote from Lil Nel
    Well, I certainly don't disagree with the findings of the Commission. But where I am not completely comfortable with their recommendations is the use Suboxone.

    In my opinion, it is simply trading one drug for another, and what is the point of that? Also, Suboxone is widely abused by addicts. So, it may be prescribed for a good purpose, only to be abused.

    And I am curious about increased funding for recovery care under Medicaid. I support the idea. But this administration tried very hard recently to CUT millions off from Medicaid. So, how will this work?

    It will cost money to fight opioid abuse. And I don't see this administration willing to spend what it will take. We will see.
    I get the concern of just "trading one drug for another", but it's also the most effective way of treating opioid addiction and the risks that come along with it based on thorough research.

    Based on just observational studies and reports, transitioning these patients to marijuana is potentially even more effective. Which would also just be trading one drug for another, except it would be trading one of the leading causes of preventable death with something that has never been shown to have killed anyone and is relatively safe.
  7. by   herring_RN
    I couldn’t read the Washington Post article so looked up what I think is the same report. It may be my computer, or that I didn't subscribe to the WAPO.
    Only the titles of the listed proposals are copied here.
    I'm glad something is being done. I'm far from expert in addiction treatment. I support a BIG effore and will gladly pay taxes to save lives and improve health.
    The Commission is additionally proposing the following recommendations for action:
    • Rapidly increase treatment capacity. Grant waiver approvals for all 50 states to quickly eliminate barriers to treatment resulting from the federal Institutes for Mental Diseases (IMD) exclusion within the Medicaid program. This will immediately open treatment to thousands of Americans in existing facilities in all 50 states.
    • Mandate prescriber education initiatives with the assistance of medical and dental schools across the country to enhance prevention efforts. Mandate medical education training in opioid prescribing and risks of developing an SUD by amending the Controlled Substance Act to require all Drug Enforcement Administration (DEA) registrants to take a course in proper treatment of pain. HHS should work with partners to ensure additional training opportunities, including continuing education courses for professionals.
    • Immediately establish and fund a federal incentive to enhance access to Medication Assisted Treatment (MAT). Require that all modes of MAT are offered at every licensed MAT facility and that those decisions are based on what is best for the patient. Partner with the National Institutes of Health (NIH) and the industry to facilitate testing and development of new MAT treatments.
    • Provide model legislation for states to allow naloxone dispensing via standing orders, as well as requiring the prescribing of naloxone with high-risk opioid prescriptions; we must equip all law enforcement in the United States with naloxone to save lives.
    • Prioritize funding and manpower to the Department of Homeland Security’s (DHS) Customs and Border Protection, the DOJ Federal Bureau of Investigation (FBI), and the DEA to quickly develop fentanyl detection sensors and disseminate them to federal, state, local, and tribal law enforcement agencies. Support federal legislation to staunch the flow of deadly synthetic opioids through the U.S. Postal Service (USPS).
    • Provide federal funding and technical support to states to enhance interstate data sharing among state-based prescription drug monitoring programs (PDMPs) to better track patient-specific prescription data and support regional law enforcement in cases of controlled substance diversion. Ensure federal health care systems, including Veteran’s Hospitals, participate in state-based data sharing.
    • Better align, through regulation, patient privacy laws specific to addiction with the Health Insurance Portability and Accountability Act (HIPAA) to ensure that information about SUDs be made available to medical professionals treating and prescribing medication to a patient. This could be done through the bipartisan Overdose Prevention and Patient Safety Act/Jessie’s Law.
    • Enforce the Mental Health Parity and Addiction Equity Act (MHPAEA) with a standardized parity compliance tool to ensure health plans cannot impose less favorable benefits for mental health and substance use diagnoses verses physical health diagnoses.
    https://www.whitehouse.gov/sites/whi...rim-report.pdf
  8. by   Lil Nel
    It's just my personal experience. I have heard folks in recovery talking about abusing Suboxone, and I worked as a pharmacy technician and certainly was aware of the abuse going on.

    I think Suboxone is BIG business. And as long as there is a big profit to be made, it will be promoted.

    Believe me, I do view addiction as an illness, not a character flaw, and realize these folks need a lot of support, but I don't think Suboxone is the answer. I would be more inclined to switch folks to marijuana.
  9. by   herring_RN
    To Grow Market Share, A Drug maker Pitches Its Product To Judges
    ... Vivitrol is a monthly injection of naltrexone, which blocks opioid receptors in the brain. It's one of three medications approved by the Food and Drug Administration for treating opioid addiction. While it's effective in some people, it's not for everyone. Patients have to be ready to be opioid-free, and some patients won't do well on it. It can also have side effects...

    ... Some courts offer participants a full range of evidence-based treatment, including medication-assisted treatment. Others don't allow addiction medications at all. And some permit just one: Vivitrol...

    ... One reason for this preference is that Alkermes, the drug's manufacturer, is doing something nearly unheard of for a pharmaceutical company: It is marketing directly to drug court judges and other officials.

    The strategy capitalizes on a market primed to prefer their product. Judges, prosecutors and other criminal justice officials can be suspicious of the other FDA-approved addiction medications, buprenorphine and methadone, because they are themselves opioids. Alkermes promotes its product as "nonaddictive."...
    Pharmaceutical Company Behind Vivitrol Markets Addiction Treatment To Judges : Shots - Health News : NPR
  10. by   elkpark
    Quote from herring_RN
    To Grow Market Share, A Drug maker Pitches Its Product To Judges
    ... Vivitrol is a monthly injection of naltrexone, which blocks opioid receptors in the brain. It's one of three medications approved by the Food and Drug Administration for treating opioid addiction. While it's effective in some people, it's not for everyone. Patients have to be ready to be opioid-free, and some patients won't do well on it. It can also have side effects...

    ... Some courts offer participants a full range of evidence-based treatment, including medication-assisted treatment. Others don't allow addiction medications at all. And some permit just one: Vivitrol...

    ... One reason for this preference is that Alkermes, the drug's manufacturer, is doing something nearly unheard of for a pharmaceutical company: It is marketing directly to drug court judges and other officials.

    The strategy capitalizes on a market primed to prefer their product. Judges, prosecutors and other criminal justice officials can be suspicious of the other FDA-approved addiction medications, buprenorphine and methadone, because they are themselves opioids. Alkermes promotes its product as "nonaddictive."...
    Pharmaceutical Company Behind Vivitrol Markets Addiction Treatment To Judges : Shots - Health News : NPR
    I heard this report this morning on NPR -- I was pretty shocked.
  11. by   BCgradnurse
    Marketing drugs to judges and courts is a little too slick for me. I hate direct to patient marketing. Patients come in and ask for drugs they see on TV, that are either inappropriate or wildly expensive. The one they market for Non-small cell lung cancer makes me physically ill. They make it sound like a miracle, but in reality it might give a patient another month or two. Bunch of used car salesmen, in my opinion.
  12. by   nursej22
    Quote from Lil Nel
    It's just my personal experience. I have heard folks in recovery talking about abusing Suboxone, and I worked as a pharmacy technician and certainly was aware of the abuse going on.

    I think Suboxone is BIG business. And as long as there is a big profit to be made, it will be promoted.

    Believe me, I do view addiction as an illness, not a character flaw, and realize these folks need a lot of support, but I don't think Suboxone is the answer. I would be more inclined to switch folks to marijuana.
    I too would like to see if marijuana could be used, especially in chronic pain cases. Unfortunately our current US attorney general is very anti-pot, and it is still a Class 1 scheduled drug.
  13. by   Lil Nel
    I had heard the NPR story several of you referenced in a different format a few weeks ago. That is exactly what I meant by big business. Couple that with only certain doctors are able to prescribe these drugs, and at least in Kentucky, they are limited to the number of patients they can see, and the situation is perfect for abuse.

    Kentucky hasn't legalized medical marijuana. We are behind the times on that issue, and that is one of the things the President of KNA and I discussed the other day. She wants nurses to be better educated on this issue.
  14. by   Extra Pickles
    Quote from BCgradnurse
    Marketing drugs to judges and courts is a little too slick for me. I hate direct to patient marketing. Patients come in and ask for drugs they see on TV, that are either inappropriate or wildly expensive. The one they market for Non-small cell lung cancer makes me physically ill. They make it sound like a miracle, but in reality it might give a patient another month or two. Bunch of used car salesmen, in my opinion.
    Yup. Although a little unfair to used car salesmen!

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