Fatal drug overdoses are now the leading cause of injury death in the United States, surpassing both car crashes and homicides. In a previous post, I mentioned that an estimated 6.9 million Americans experienced substance use or dependence issues within the past year, and almost 2.5 million of these involved opioids such as prescription painkillers and heroin. Despite this epidemic, in 2013, less than 20 percent of all individuals with substance use disorders (SUD), including less than 11 percent of those under age 25, received treatment. To address this public health crisis, legislation was recently introduced in Congress to help ensure that treatment is available to all who need it. The legislation focuses on prescription monitoring, overdose prevention, and treatment.
Most medical practitioners receive little to no training in treating chronic pain or the appropriate prescribing of controlled substances. In recent years, some states have instituted mandatory continuing medical education requirements on these topics, but most still have no requirement that medical providers receive training or demonstrate proficiency in pain treatment and substance use issues. The Safer Prescribing of Controlled Substances Act would address these shortcomings at the federal level by requiring all practitioners to receive appropriate training, including in the use of prescription drug monitoring programs, as a condition to obtaining or renewing a DEA license to prescribe controlled substances.
Improving provider education is an important step, but health experts agree that these efforts must be combined with other best practices such as improving access to SUD treatment and increasing the availability of the opioid antidote naloxone.
The Opioid Overdose Reduction Act of 2015 would provide civil immunity to health care professionals who prescribe or dispense naloxone. The act would also provide civil immunity to opioid overdose program representatives and individuals who administer naloxone to persons experiencing an overdose. Similar laws enacted in at least 30 states have successfully increased access to naloxone, and this law would extend these benefits nationwide.
However, while naloxone can save lives, more comprehensive treatment is needed to prevent overdose in the first place.
The Recovery Enhancement for Addiction Treatment Act (TREAT Act) seeks to improve access to one particularly promising option for opioid dependence, medication-assisted treatment (MAT). MAT combines the use of prescription medications with counseling and behavioral therapy in treating substance use disorders, and has been shown to improve both health outcomes, including hepatitis C infection rates, and key social determinants such as employment. Despite these benefits, in 2012, fewer than 40 percent of those who abused or were dependent on opioids received MAT.
The TREAT Act would remove legal barriers such as caps on the number of patients any single physician can treat with buprenorphine and limitations on the type of practitioners who can provide MAT. Unlike methadone maintenance therapy, which may only be provided in certified Opioid Treatment Programs that are limited in number and often lack the capacity to treat additional patients, the Drug Addiction Treatment Act of 2000 permits qualified physicians to provide buprenorphine treatment in their regular course of practice.
Current law limits these physicians to treating no more than 30 patients unless the physician has provided such treatment for at least one year and receives a waiver to treat up to 100 patients. The TREAT Act would raise these caps to 100 patients initially, and an unlimited number under an approved waiver. Perhaps more importantly, the law would increase the number of available providers by allowing certain physician assistants and nurse practitioners to offer MAT.
Similarly, the Treatment and Recovery Investment Act would authorize funding – more than $300 million in 2016 alone – to support these expanded SUD treatment services, particularly those targeted at children and pregnant and parenting women.
Finally, the Supporting Positive Outcomes After Release Act would prohibit states from terminating an individual’s Medicaid enrollment when that individual is incarcerated. As previously discussed, an individual’s enrollment in Medicaid following release is positively associated with the increased use of substance use disorder services and reduced recidivism rates. Existing state policies vary significantly, and this legislation would provide a uniform national standard.
Together, these proposals represent important opportunities to dramatically expand SUD treatment services and reduce drug-related harm.
This post was developed by Derek Carr, J.D., Legal Fellow at the Network for Public Health Law – Southeastern Region at the National Health Law Program (NHeLP).
The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided in this post does not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state.
Support for the Network is provided by the Robert Wood Johnson Foundation (RWJF). The views expressed in this post do not necessarily represent the views of, and should not be attributed to, RWJF.