Steps the federal government can take for combating opioids

President Trump last week called the opioid epidemic a national emergency. Declaring an emergency on the opioid epidemic will send an important message and may help address some of the stigma that prevents people from seeking help.

The statement alone does not invoke federal government emergency authorities and federal staff must now determine under which authority an official declaration can be made. Various options exist, the president can declare an emergency declaration under the Stafford Act, usually used for natural disaster declarations, and the Secretary of Health and Human Services can declare an emergency under Section 319 of the Public Health Services Act.

Under the Public Health Services Act, the Secretary has authority to take various actions, including accessing the Public Health Emergency Fund and deploying personnel to affected areas.

Regardless of the authority used, an emergency declaration requires immediate action followed by swift results. Any steps taken will build upon the $1B in federal funding authorized in the 21st Century Cures Act during the Obama administration to scale up treatment efforts in the states.

As outlined in Governor Chris Christie’s recently released interim report on the epidemic, the federal government should continue to address the opioid issue from a public health perspective and work to ensure that Americans have access to healthcare. Here are a few suggestions for how the unique resources of the federal government can be deployed to address the epidemic in the wake of an emergency declaration.

First, deploy federal public health professionals, for example, Public Health Service personnel, to hot spots.Hot spots can include areas with high opioid involved overdose rates and high opioid prescribing rates. While rates of opioid prescribing have decreased in recent years, there are still three times as many opioids prescribed today as in 1999. The majority of individuals who misuse prescription drugs get them from family or friends for free, followed by one prescriber.

Overprescribing has led to an excessive number of prescriptions that are diverted and misused, which can lead to a subsequent opioid use disorder. To bring down opioid prescribing rates, the Centers for Disease Control and Prevention (CDC) Opioid Prescriber Guideline is a significant resource for prescribers. CDC is disseminating the guideline but training on the guideline is voluntary and not necessarily targeted to areas of highest need.

Public health professionals deployed to targeted regions could provide in depth training and mentorship to help bring down excessive opioid prescribing rates.

Bringing down prescribing rates cannot be done in a vacuum. A patient who has developed an opioid use disorder and is suddenly cut off from prescription opioids can suffer serious unintended consequences, including overdose and death, as the person turns to illicit opioids.

Therefore, in addition to training on the CDC Prescriber Guideline, public health professionals should be deployed to these hot spots, as well as areas with high heroin and fentanyl-involved overdose rates, to provide supplemental treatment resources.

Public health professionals should receive data waiver training to prescribe buprenorphine, one of the three FDA approved medications used to treat opioid use disorders. Upon completion of the training, federal agencies charged with the training and certification process, (the Substance Abuse and Mental Health Services Administration and the Drug Enforcement Administration), should be required to expedite the approval process.

These trained public health professionals would be deployed to work in the community with local physicians and, where allowed under state law to prescribe, with nurse practitioners to expand local capacity to treat opioid use disorders.

This partnership is essential to build the community capacity needed to address substance use disorders, both today and into the future. In addition, other forms of medication assisted treatment (methadone and naltrexone) should be scaled up and made available. In conjunction with increasing access to medication assisted treatment, it is also essential that other behavioral health professionals be deployed to provide the type of comprehensive care needed for effective treatment. AmeriCorps volunteers and recovery advocates could be deployed to these same targeted areas to provide referrals to resources such as treatment, employment, or housing to those with substance use disorders.

There are many other efforts that must be part of any comprehensive response, to include prevention efforts aimed at young people, expanding syringe services programs in areas where injection drug use is prevalent, and additional federal funds to make naloxone available to people at risk for overdose, their families, and first responders.

But deploying public health professionals from the federal government to targeted areas will help build the infrastructure necessary to deal with the epidemic.These steps can be taken immediately to bring down rates of overdose deaths and this type of deployment, combined with capacity building, will leave communities with a lasting treatment infrastructure.

Regina LaBelle served as chief of staff and senior policy advisor at the Office of National Drug Control Policy during the Obama administration. Currently, she is a principal with LaBelle Strategies and provides consulting services to governments and nonprofits seeking to end the opioid epidemic.


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