New Opioid 'Roadmap' Offers Suggestions to Combat Abuse

Kerry Dooley Young

June 21, 2018

WASHINGTON — A broad coalition of more than 70 organizations yesterday released what it calls a "roadmap" for addressing opioid abuse, which offers recommendations on pain management and increased sharing of information about patients' past substance abuse, the Healthcare Leadership Council said.

"This public health crisis requires a comprehensive approach spanning the entire healthcare spectrum, public and private sectors alike," said Mary R. Grealy, JD, president of the Healthcare Leadership Council, which spearheaded this effort. "We all have to be part of the solution."

The Healthcare Leadership Council, which includes a coalition of chief executives from many parts of the medical community, said the new set of recommendations reflects months of work in building consensus. 

Opioid misuse has had a devastating impact on communities across the United States, with more than 350,000 people dying from opioid-related overdose between 1999 and 2016, the council said in its proposal.

Its "roadmap" offers suggestions for leaders of healthcare organizations and federal agencies as well as members of Congress. These include improved patient access to alternatives to opioids for managing pain, adoption of e-prescribing for all controlled substances by 2020, and the development of a system to provide real-time prescribing data on a national basis.

Other suggestions from the roadmap proposal include:

  • Federal and state officials should revise regulations and reimbursement policies to expanded use of telemedicine, as well as in-home and community-based substance-abuse treatment programs for medically underserved populations.

  • Congress should amend federal regulations on confidentiality of substance-use disorder (SUD) records, known as 42 CFR Part 2,  to align with the Health Insurance Portability and Accountability Act (HIPAA) for the purposes of healthcare treatment, payment, and operations. "Allowing confidential sharing of information on SUD diagnosis history can help improve patient safety, quality, and care coordination and ensure that the privacy of patients undergoing SUD treatment is protected," the proposal said.

  • The Centers for Medicare and Medicaid Services (CMS) should review and modify its reimbursement policies to remove any barriers to use of multimodal pain treatment (including nonopioid, opioid-sparing, and nonpharmacologic therapies). Where appropriate, CMS should offer guidance to state Medicaid programs on these matters.

  • States should authorize pharmacy benefit managers (PBMs), commercial insurers, Medicare, and Medicaid to allow access to prescription drug monitoring program data for enrolled patients. Agreements for sharing this data with third-party payers should build in protections for patient privacy, data security, and protection.

"An Important Step"

"This is not the end of the line, but it is an important step toward addressing this national crisis," said Mark B. McClellan, MD, PhD, who served as chief of the Food and Drug Administration and of CMS in the George W. Bush administration, about the roadmap at a Wednesday press conference.

Since 2013, McClellan has been on the board of directors for Johnson & Johnson. He is also the director of the Duke-Margolis Health Policy Center, which aided in the development of the Healthcare Leadership Council's roadmap.

The roadmap also calls for greater discussion of best practices for improving what's known as opioid stewardship in healthcare settings. Hospitals and medical organizations already are working to remove leftover pills from opioid prescriptions from homes and other settings where they can prove a temptation for people who may want to experiment with or abuse these drugs.

At the Wednesday press conference, Robert Wyllie, MD, chief of medical operations of the  Cleveland Clinic, told of early results seen from putting out receptacles to allow collection of unused medicines.

"We collected forty pounds of drugs in the first day after, so that just gives you an idea of the residual drugs which are out there," he said.

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