The Opioid Crisis: What is the Government Doing About It?
There can be little doubt that the opioid crisis has reached staggering levels. The Centers for Disease Control and Prevention (CDC) statistics from 2016 reveal that on average, opioids killed about 115 Americans every day. Drug overdoses have become the leading cause of death in Americans under the age of 50, with opioids accounting for two-thirds of those overdose-related deaths. It goes without saying that workers’ compensation claimants are particularly vulnerable to opioid addiction due to the high incidence of prescription drug utilization in this population. In October 2017, President Trump directed the Department of Health and Human Services (HHS) to declare the opioid crisis a public health emergency. Earlier this year, HHS revealed a five-point strategy to be used in the fight against opioids.
The five-point strategy consists of the following themes: improving access to treatment and recovery services, using data to better understand the epidemic, advancing better practices for pain management, increasing the availability of overdose-reversing drugs and supporting new, novel research on pain and addition. Over the next several months, MEDVAL will provide a blog series examining each component of the Federal plan in more detail, beginning with this first post focusing on the first prong of the five-point strategy.
The first prong of the opioid plan is to improve access to treatment and recovery services. In 2017, HHS issued $800 million in grant funding to support improved access to opioid treatment, prevention and recovery. One example of such funding was the First Responders – Comprehensive Addiction and Recovery Act (FR – CARA), which dedicated $44.7 million to additional training and medication supplies for emergency personnel. HHS also devoted funding to the publication of resources and media materials intended to increase awareness and slow progression of the epidemic. One such example was the Rx Awareness Campaign, which was launched by the CDC to highlight the prevalence of addiction and the risks associated with prescription opioids. The impact of the public health emergency declaration is the availability of additional funding from the Public Health Emergency Fund, although the particular details about future funding efforts have not been announced.
Improving access to recovery services has highlighted a long-standing barrier to the treatment of opioid addiction, which is the statutory prohibition against state Medicaid coverage of substance abuse services when those services are rendered in institutions of mental disease (IMD), such as residential treatment facilities. In response to President Trump’s directive, CMS announced greater flexibility with an existing policy that allows states to apply for Section 1115 demonstration waivers. Section 1115 waivers provide funding for the treatment of substance use disorders in IMD facilities, allowing state Medicaid programs to cover these services as an exception to the statutory prohibition. As of March 2018, CMS had approved waiver requests in ten states, with ten additional waiver applications pending. New Jersey’s demonstration waiver was approved in November 2017. Governor Chris Christie applauded CMS’ action, stating “This is a tremendous step forward in our efforts to aggressively combat the opioid epidemic and save lives.”