Recently, the U.S. Department of Health & Human Services (HHS) has focused its resources on steps to curb the opioid epidemic in the United States. Efforts have ranged from issuing and finalizing CDC’s guideline for prescribing opioids to expanding access to naloxone and increasing awareness about medication-assisted treatment (MAT). HHS announced additional actions in July that will build on those efforts.
The first includes a new rule that makes buprenorphine—a drug frequently used for MAT that, unlike methadone, can be provided outside designated treatment facilities—available to more physicians and in turn, more patients. Physicians who have had a waiver to prescribe buprenorphine for up to 100 patients for a year or more can now receive a waiver to treat up to 275 patients.
“The expansion of the buprenorphine MAT program is long overdue,” said Chris Herndon, PharmD, associate professor at Southern Illinois University Edwardsville School of Pharmacy. Next, he would like to see buprenorphine and naloxone MAT prescribing extended to pharmacists under collaborative practice or standing order agreements.
Jenna Ventresca, JD, APhA associate director of health policy, said that HHS’s ongoing efforts to address substance abuse and misuse are consistent with federal legislation and state efforts that aspire to achieve the same goals. “Like these broader efforts, the effectiveness of HHS’s recent actions will be seen through implementation activities and the health care ecosystem’s willingness to adopt and adapt to the changing substance use and abuse landscape,” she said.
HHS also introduced a proposal to eliminate any potential financial incentive for doctors to prescribe opioids based on patient experience survey questions. HHS said in order to reduce the perception that there is financial pressure to overprescribe opioids, CMS wants to remove the Hospital Consumer Assessment of Healthcare Providers and Systems survey pain management questions from the hospital payment scoring calculation.
Herndon believes removing pain-related questions from the surveys might be too aggressive a step.
“I, too, share the concern that these questions place undue pressure on health systems, but there are other alternatives to completely omitting them altogether. I fear that complete removal may indirectly result in untreated or undertreated pain,” he said.
HHS also included a new requirement for Indian Health Service prescribers and pharmacists to check state prescription drug monitoring program (PDMP) databases before prescribing or dispensing opioids for pain.
HHS will continue to launch research studies to understand pain and opioid addiction. New research will identify people with pain who are more likely to benefit from opioid pain medication as well as those at risk of experiencing opioid-related harms. Research will also focus on naloxone and new treatments. HHS said new studies will investigate different naloxone formulations to reverse overdoses from fentanyl and other high-potency opioids.
HHS agencies continue to expand access to naloxone and naloxone training through grants to communities high in need.
“Decreasing barriers to naloxone, in both cost and access, has already proven to save lives,” said Herndon. “Pharmacists are truly in a unique position to ensure that this medication is getting to the right people and being used appropriately.”
For additional information and resources, visit APhA’s Opioid Use, Abuse, and Misuse Resource Center on pharmacist.com.
For more information, visit www.pharmacytoday.org for the upcoming September issue of Pharmacy Today.