Opiate Commission Preliminary Report
Dr. Dawn-Elise Snipes
Executive Director: AllCEUs Counseling Education
~ In 2015, 27 million people reported current use of illegal drugs or abuse of prescription drugs.
~ Only 10 percent of the nearly 21 million citizens with a substance use disorder (SUD) receive any type of specialty treatment
~ With approximately 142 Americans dying every day, America is enduring a death toll equal to September 11th every three weeks.
~ 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 exclusion within the Medicaid program.
~ This exclusion prohibits federal Medicaid funds from reimbursing services provided in an inpatient facility treating “mental diseases” (including SUDs) that have more than 16 beds.
~ Right now, states entirely responsible for Medicaid-eligible patients in inpatient treatment facilities, including patients undergoing withdrawal management in addiction treatment facilities rather than hospitals.
~ This will immediately open treatment to thousands of Americans in existing facilities in all 50 states…Or will it?
~ Require extensive provider enrollment procedures
~ Requires extensive staff training
~ Requires extensive modifications to the HER and P&P
Training—Wish List (Basic Medicaid Training Requirements can be found here: https://allceus.com/member/cart/index/product/id/765/c/ )
~ Require all persons from technicians to clinicians and managers to receive specialty training in Addiction Counseling
~ In FL a bachelors level practitioner with specialized training in treatment of behavioral health disorders, human growth and development, evaluations, assessments, treatment planning, basic counseling and behavior management interventions, case management, clinical record documentation, psychopharmacology, abuse regulations, and recipient rights
~ Biopsychosocial evaluations
~ Group therapy services
~ Certified recovery peer specialist • Certified recovery support specialist • Certified behavioral health technicians can also provide
~ Group counseling in Day Treatment Programs
~ Community support and Rehabilitative services
~ Clubhouse services
~ Therapeutic behavioral on-site support services with persons under 21
~ Fewer than 20% of the over one million prescribers licensed to prescribe controlled substances to patients have training on
~ How to prescribe opioids safely.
~ How to screen for addiction
~ What to do if a patient has become dependent on substances or presents with an SUD
~ Mandate prescriber education initiatives with the assistance of medical and dental schools
~ Require all Drug Enforcement Administration (DEA) registrants to take a course in proper treatment of pain.
~ Work with partners to ensure additional training opportunities, including continuing education courses for professionals.
~ Promote expanded implementation of the CDC Guideline for Prescribing Opioids for Chronic Pain
~ 4 of 5 new heroin users begin with nonmedical use of prescription opioids
~ Not necessarily their own….
Medication Assisted Treatment
~ MAT has proven to reduce overdose deaths, retain persons in treatment, decrease use of heroin, reduce relapse, and prevent spread of infectious disease.
~ Only 10 percent of conventional drug treatment facilities provide MAT for opioid use disorder.
~ There are only 12 methadone clinics in TN.
~ Office based prescribers of MAT are not required to provide the counseling and support which is REQUIRED of methadone clinics.
~ Veterans and Medicare recipients have even more limited access to affordable MAT from qualified professionals
~ Recommendation: Immediately enhance access to Medication Assisted Treatment (MAT).
~ Require that all modes of MAT are offered at every licensed MAT facility
~ 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
~ Requiring the prescribing of naloxone with high-risk opioid prescriptions
~ Equip all law enforcement in the United States with naloxone to save lives.
~ Prioritize funding and manpower to
~ Department of Homeland Security’s (DHS) Customs and Border Protection
~ DOJ Federal Bureau of Investigation (FBI)
~ 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).
Data Sharing / Doctor Shopping
~ 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 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 someone with a SUD.
~ This could be done through the bipartisan Overdose Prevention and Patient Safety Act/Jessie’s Law.
~ CFR 42 part 2??
~ Enforce the Mental Health Parity and Addiction Equity Act (MHPAEA) to ensure health plans cannot impose less favorable benefits for mental health and substance use diagnoses verses physical health diagnoses.
~ What about the uninsured? (i.e. single men and persons with felony convictions)
~ What about high copays and deductibles
~ Most Americans cannot scrape together $2000 for an emergency
~ MAT costs on average $3500-$6000 per year WITHOUT counseling
~ Most people’s deductibles are over $1,000 per year
~ Evidence-based prevention programs for schools
~ Make it a priority, like the state testing
~ Tools for teachers and parents to:
~ Enhance youth knowledge of the dangers of drug use,
~ Provide early intervention strategies for children with environmental and individual risk factors (trauma, foster care, adverse childhood experiences (ACEs), and developmental disorders).
~ Physical abuse
~ Sexual abuse
~ Emotional or physical abuse or neglect
~ Intimate partner violence (dating or parental DV)
~ Substance misuse within household
~ Household mental illness (Nearly 35% of Americans)
~ Parental separation or divorce
~ Incarcerated household member
~ Examination of the need for satisfaction with pain level as a satisfaction criteria through which health care providers are evaluated by HHS.
~ Too many people expect to be pain free nearly always
Treatment Program Improvement
~ Improvements in treatment programs, based on adherence to principles of:
~ Evidence Based Treatment
~ EBPs are expensive and challenging to implement “to fidelity.”
~ Continuum of care
~ Outcome measures
~ Patient education on quality treatment
Other Areas for Evaluation
~ Targeted data collection and analytics needed to identify most effective prevention and treatment strategies, quality treatment access programs, reimbursements, and aid to law enforcement activities.
~ Develop a behavioral health surveillance system run through CDC that tracks prevalence rates, treatment modalities, and comorbidities with other illnesses in real-time.