Opioids, Legislation, and Healthcare Policy

As most of the pain community knows, the House of Representatives (HOR) passed HR6 in June 2018.

Many of the provisions of HR6 are aimed at Medicare and Medicaid recipients.

This bill makes several changes to state Medicaid programs to address opioid and substance use disorders.

Check out the text summary of HR6 stating it:

  • modifies provisions related to coverage for juvenile inmates and former foster care youth,
  • establishes a demonstration project to increase provider treatment capacity for substance use disorders,
  • requires the establishment of drug management programs for at-risk beneficiaries,
  • establishes drug review and utilization requirements,
  • extends the enhanced federal matching rate for expenditures regarding substance use disorder health home services, and
  • temporarily requires coverage of medication-assisted treatment.

The bill also alters Medicare requirements to address opioid use. Specifically, the bill:

  • exempts substance use disorder telehealth services from specified requirements,
  • requires the initial examination for new enrollees to include an opioid use disorder screening,
  • modifies provisions regarding electronic prescriptions and post-surgical pain management,
  • requires prescription drug plan sponsors to establish drug management programs for at-risk beneficiaries, and
  • requires coverage for services provided by certified opioid treatment programs.”

Senate Bills

With the urging of President Trump, the Senate recently voted and passed their version of the HOR approved bill HR6 creating a sweeping package that contains 70 bills from Republican and Democratic lawmakers

In the article on chicagotribune.com “Senate Reaches Agreement on Opioids Package; Bill to be Voted on Next Week by Colby Itkowitz  reports that President Trump (POTUS) urged the Senate to swiftly vote on opioid bills.

Trump increased the pressure by tweeting that they must pass the Portman-sponsored bill on shipments of illicit fentanyl through the international postal system stating “It is outrageous that Poisonous Synthetic Heroin Fentanyl comes pouring into the U.S. Postal System from China,” Trump wrote on Twitter. “We can, and must, END THIS NOW! The Senate should pass the STOP ACT – and firmly STOP this poison from killing our children and destroying our country. No more delay!”

Illicit Fentanyl Analogs

While illicit analogs flooding the country widely impacting overdose deaths is a vital issue, it should also be noted the POTUS only publicly denounced the shipments of illicit and illegal Fentanyl analogs to the United States just ahead of mid-term elections and certainly, not prior to rolling out restrictive draconian healthcare policy now impacting millions of patients experiencing acute/ chronic/ intractable pain.

In an article “Opioid Overdose Crisis Is from Illicit Fentanyl” in the Journal of American Physicians and Surgeons published by the Association of American Physicians and Surgeons (AAPS), a national organization representing physicians in all specialties since 1943 states:

The U.S. is said to be suffering from a crisis in deaths from opioid overdoses, prompting legislative and other efforts to clamp down on physician prescribing of these drugs.

However, this effort is likely misdirected, and targeting legal prescriptions is thus unlikely to reduce overdose deaths, according to a careful review of official government data by John D. Lilly, M.B.A., D.O., in the spring issue of the Journal of American Physicians and Surgeons.

Until 2013, deaths attributed to synthetic opioids were fairly stable, but a sharp upward trend began then, with an increase of 635% from 2014 to 2016.

The National Institute on Drug Abuse (NIDA) uses the International Classification of Diseases, 10th revision (ICD-10), to identify causes of death, but NIDA’s overlapping categories can be confusing.

Using data from the Centers for Disease Control and Prevention (CDC) Wonder data base, Dr. Lilly sorts out the deaths associated with illicit fentanyl. The main sources of illicit fentanyl are Mexico and China.

It is often mixed with heroin.

Conclusion: Not all opioids are identical in abuse potential and likely
lethality, yet government statistics group causes of death in
a way that obscures the importance of identifying specific
agents involved in deadly overdoses.

Searching the CDC: Wonder database reveals that the recent spike in deaths is primarily due to illicit fentanyl. Targeting legal prescriptions is thus unlikely to reduce overdose deaths, but it may
increase them by driving more users to illegal sources.

John D. Lilly, M.B.A., D.O., practices family medicine in Springfield, MO.

Full Article: http://www.jpands.org/vol23no1/lilly.pdf

It is now public knowledge that illicit analogs are the culprit for many opioid deaths, and NOT prescribed opioids,  as previously and repeatedly postulated, it warrants for constituents to demand that legislators and the POTUS enact protections for pain patients and their healthcare providers.

What’s Missing?

To narrow down what was, or was not included in the Senate bill presented to POTUS, check out this additional article by Colby Itkowitz for the Washington Post.

The Health 202: Here’s what is in the Senate Opioid Bill — and what didn’t make the cut”

or, you can check out National Pain Report’s article “Opioid Bill Heading to the White House – It’s About Addiction Not Chronic Pain” by Ed Coghlan for a more detailed or expansive discussion of what is contained in the bills being sent to the POTUS for approval.

The HOR and the Senate have prepared a comprehensive legislation package  and have now presented it to the POTUS for approval/signature, and the pain community must ask the POTUS where are the patient protections for acute/ chronic/ intractable pain patients?

Pain Patient Protection

So, what is missing in the legislation?

We know what is missing!

Provisions to protect patients and their healthcare providers.

The legislation passed by the HOR and the Senate definitely placate to their stakeholders extending an anti-opioid narrative regardless of the negative impact to the pain community, and it does not provide protections for patients experiencing pain regardless of lack of evidence and skewed data.

We submit that the POTUS is now doing the same.

This is the pain community’s opportunity to give the White House feedback about this legislation and the lack of patient protections for patients experiencing pain and the negative consequences of under-treated pain.

As a result, we are encouraging the pain community to reach out to President Trump and ask “where are the patient protections for the pain community and their healthcare providers?”

You can call the POTUS/ White House at Phone Number: 1-202-456-1414 (Switchboard)and 1-202-456-1111 (Comments).

For more lengthy comments, consider sending your feedback via the White House contact form.

Tracking Ongoing Legislation

If you would like to track federal legislation impacting the pain community check out Congress.gov as an online tool to verify which bills are introduced, passed by the HOR/ Senate, and which bills are sent to President Trump (POTUS) for approval.

Thanks to Colby Itkowitz, chicagotribune.com, washingtonpost,com Dr. Lilly, Ed Coghlan, National Pain Report and congress.gov for their informative articles and online tools.

Do you think the proposed legislation should include patient protections to protect individualized patient care?

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