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HHS Announces New Opioid Reform Policies

July 6, 2016
As part of the US Health and Human Services' (HHS) efforts to combat the rising trends in opioid abuse and deaths in the nation, the department announced a series of new initiatives, including expanding access to buprenorphine.

Photo courtesy of the department of Health and Human Services.

The US Health and Human Services (HHS) is taking several new initiatives in response to growing concerns over the nation’s opioid epidemic.1

The actions include:

  • Expanding access to buprenorphine
  • Submitting a proposal to stop any financial incentive for practitioners to prescribe opioids based on patient experience survey questions (aka, Hospital Consumer Assessment of Healthcare Providers and Systems surveys, which ask patients about their pain management experience).
  • Creating a requirement for Indian Health Service (IHS) prescribers and pharmacists to use state Prescription Drug Monitoring Program (PDMP) databases before providing opioids to a patient

The announcement comes as the latest development since the HHS announced its Opioid Initiative campaign back in March of last year, part of the federal government’s National Pain Strategy, which is focused on curbing the high rates of opioid abuse and overdose deaths in the US.

“More Americans now die from drug overdoses than car crashes, and these overdoses have hit families from every walk of life and across our entire nation,” said HHS Secretary Sylvia M. Burwell, who made the HHS’s announcement in a press release today.

“At HHS, we are helping to lead the nationwide effort to address the opioid epidemic by taking a targeted approach focused on prevention, treatment, and intervention. These actions build on this approach. However, if we truly want to turn the tide on this epidemic, Congress should approve the President’s $1.1 billion budget request for this work,” added the secretary.

Expanding Access to Buprenorphine

One of the main aims of the HHS’s Opioid Initiative has been expanding access and awareness about Medication Assisted Treatment (MAT) programs, which commonly use buprenorphine. An opioid partial agonist, buprenorphine is effective for treating opioid dependence and is now available as a long-term implant.

A rule finalized today by the Substance Abuse and Mental Health Services Administration (SAMHSA) will enable practitioners to expand prescribing limits of the drug. For doctors who held a waiver for prescribing buprenorphine for up to 100 patients for a year or more duration, they now can obtain a waiver to expand buprenorphine prescribing to 275 patients.

However, in order to obtain this waiver, practitioners must have additional credentials in addiction medicine or addiction psychiatry, which can be earned from a specialty medical board or professional society, or a practitioner must practice in a qualified setting as described in the rule, according to the press release.

Andrew W. Gurman, MD, president of the American Medical Association (AMA), applauded the HHS’s decision to leverage more support for MAT programs. “Medication assisted treatment is proven effective, but for too long, too many patients have lacked access to this treatment. Today’s final rule is an important step that nearly triples the number of patients practitioners may treat with a waiver, but more must be done to leverage trained physicians to close the treatment gap,” said Dr. Gurman in an AMA press release.

Delinking HCAHPS Survey Results from Medicare Payments to Hospitals

The Centers for Medicare and Medicaid Services (CMS) is proposing to remove Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey that includes questions on pain management from hospital payment scoring calculations. These survey scores incorporate pain management questions, and prior to this decision, have been tied to Medicare payments hospitals receive.

Hospitals still can use the survey questions to get feedback from patients about their inpatient pain management experience. However, the questions no longer will affect the Medicare payments , which is intended to remove any possible financial pressure to overprescribe opioids in the clinical setting.

Incorporating More HIS Participation in PDMPs

Many IHS clinicians already utilize PDMP databases. But to expand participation, the agency now will require IHS providers to check a PDMP database prior to prescribing or dispensing an opioid for more than 7 days. This will take immediate effect for the over 1,200 IHS clinicians working in IHS federally operated facilities. The IHS also announced Bureau of Indian Affairs law enforcement officers will be trained on how to use naloxone, an opioid overdose antidote that is now becoming more widely available for first-responders and family members.

Increasing Research and Education

Lastly, the HHS also has plans to kick start “over a dozen” new studies into opioid misuse and pain management, the press release said. For anyone interested the new research initiatives, the HHS has a report and inventory that provides more information on these activities. This infographic also gives a comprehensive look at the HHS’s research priorities.

The HHS is actively involved in providing more educational materials and resources for practitioners and patients to raise awareness about the dangers of prescription opioid misuse, abuse, dependence, and overdose, something also being done by various professional organizations, including the AMA, which provides a variety of free resources and information for doctors and patients.

The AMA also currently is supporting bipartisan legislation to eliminate a potential penalty on prescribers who refuse to overprescribe opioids, a bill introduced by U.S. Representative Alex X. Mooney (R, WV 2nd District) back in February. H.R. 4499, titled the Promoting Responsible Opioid Prescribing Act, is intended to have the same effect as the new HCAHPS proposal, except with congressional support behind it.

Last updated on: July 25, 2016
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HHS Releases Steps to Stem Opioid-related Overdose, Death and Dependence