Michael T. Flaherty, Ph.D.
Annapolis Coalition Board Member and Lead on Substance Use Disorders
For the past ten years, many local, state and national plans have been promulgated to address the still-expanding “epidemic” of opioid use and overdose in America. Most recent is the release of the report from the “President’s Commission on Combating Drug Addiction and the Opioid Crisis.” The Commission was chaired by Gov. Chris Christie and included Governors Charlie Baker and Roy Cooper, Representative Patrick Kennedy, Professor Bertha Madras and Florida Attorney General, Pam Bondi. The Commission’s report was sent as a “draft” to the President November 1, 2017, for review and further Congressional support and national and local implementation. The report notes that 175 American citizens now die each day from this “epidemic” and that “Congress must act … as soon as possible” to take all steps needed for implementation.
In the report, some 56 recommendations are made and while funding is not included, in the eyes of many, the report does understand implementation issues and well identify system, treatment and community needed changes and solutions. For example, the report underscores at a macro level the need for public safety and public health efforts to work “aggressively” alongside one another to reduce supply and demand while expanding community prevention, early intervention, treatment (especially medication-assisted treatment) and recovery. As with previous reports, successful programs such as Prescription Drug Monitoring Programs, Drug Turn Back Boxes and increasing the availability of life-saving NARCAN are noted BUT with specific advancements recommended such as requiring all federally employed prescribers have special training in fighting this epidemic including being able to prescribe buprenorphine; and that all police nationally be required to carry NARCAN. To avoid bureaucratic barriers the report suggests simply to “block grant” new funds to the states to address opioid issues more quickly and as best they discern. ONDCP, instead of being dismantled, is empowered to “develop and coordinate a national drug policy” and to monitor funds and their accountability in implementation as well as coordinate those efforts along with the departments of HHS and DOJ. Federal Drug Courts, currently existing in only 60% of the federal regions are recommended for all 97 Federal Districts as are state drug courts for all counties. These are but a few of the specific system actions recommended.
With more than half of the nation’s population not having geographical access to a treatment facility, the report underscores a need for across the board expansion of substance use care while circumscribing an expanded workforce needed to address overdose inclusive of doctors in all specialties, addiction treatment and prevention experts, parents, schools, those in recovery, faith-based leaders, law enforcement, insurers, the medical and prescribing industry and researchers. The report predicts the continued shortage of skilled workers to grow to 250,000 more needed by 2025 – if the problem and substance use itself is to be met head-on. To address this shortfall all disciplines are asked to strengthen their substance use knowledge and competence and are to be augmented by new workers such as Peer Supports, Recovery Coaches and most of all, “Community Health Workers” who have specific training, experience, and competence to address the “epidemic” for each community. The National Health Service Corps is called upon to develop these workers specifically in high overdose regions. Emergency workers would especially be skilled-up to address overdose and assist in assuring linkage to treatment. Hospitals would be incentivized to treat substance use and train staff in ERs for higher levels of recognition, acceptance, and response. Treatment links would be stronger, and recovery supports, short and long-term, would be linked to all.
The report has shortcomings. Funding and actions to incent implementation are the biggest. The recognition and assessed impact of existing “stigma” is another. Still, this report has more practical national, state and local solutions than earlier reports and is worth reading and finding ways to implement as soon as possible.
The full report is available here.