President’s Commission on Combating Addiction and the Opioid Crisis

President Trump’s commission issued its final report of findings and recommendations regarding the Opioid epidemic on Wednesday, November 1st.

I believe this is a positive step in the right direction, as several of the issues and concerns frequently noted by those who work in the addiction treatment field are finally given some attention. I recently wrote a blog and posted a Facebook live discussion in which many of these concerns were noted (View Facebook Live Feed Here), and I’m pleased to see that the commission appears to understand some of the issues.

Although these are simply recommendations that have not yet been implemented or funded, it provides a potential platform for consideration and hopefully execution by congress and the current administration.

 The report contains fifty-six recommendations within the following areas:

  • Federal funding and programs

  • Opioid addiction prevention;

  • Prescribing guidelines, regulations, and education;

  • PDMP (Prescription Drug Monitoring Program) enhancements;

  • Supply reduction and enforcement strategies;

  • Opioid addiction treatment, overdose reversal, and recovery;

  • Research and development.

Twenty-one of the commission’s recommendations specifically address opioid addiction treatment and recovery. While I will not detail all of these recommendations, I want to highlight a few that I believe are promising, well overdue, and which could help provide more treatment opportunities to those in dire need.

They recommend the adoption of process, outcome, and prognostic measures. Addiction treatment has long needed a more formalized and evidenced based structure and this may force unskilled providers, at times with the wrong intentions, to step out of the industry.

The commission recommends certain government funded healthcare entities to reduce or illuminate reimbursement and barriers to SUD (Substance Use Disorder) treatment.  Among these are the elimination of “fail-first protocols” such as when insurance carriers deny clinically recommended treatment by requiring an individual to first fail at a lower level of care.

They recommend that HHS (The United Stated Department of Health and Human Services) consider and modify reimbursement rates to better cover the cost of SUD. They further recommend that private sector insurers review their reimbursement rates in order to increase in-network addiction treatment providers.  Low rates of reimbursement often prevent good providers from being able to enter insurance networks and treat those in need who could not otherwise afford services.

The commission goes on to recommend increased monitoring and oversight of health insurers to ensure penalties for parity law violations. Hence enforcing the law that requires behavioral health difficulties to be covered at a commensurate level with medical ailments. The commission recommends guidelines and reimbursement for recovery support services such as peer to peer programs, job training, supportive housing and sober housing.

They also recommended taking a look at zoning restrictions that create barriers to treatment. Problems with NIMBY (Not In My Backyard) have been extremely common in addiction treatment and housing. Additionally, they discuss the identification and implementation of college recovery programs and sober student housing.

While many of the recommendations and funding suggestions fall within the federal level,  standards for care and treatment tend to stem from HHS ( Department of Health and Human Services) and CMS (Center for Medicare and Medicaid Services) guidelines. If positive changes for SUD treatment are implemented at the federal level, hopefully the changes will become widespread and enforceable to commercial insurance companies as well.

Read the Full Report - The President's Commission on Combating Drug Addiction and The Opioid Crisis - Download PDF