Friday, October 27, 2017

Trump's opioid emergency declaration has no money, but could free up some and offer other aid

President Trump' declaration that the opioid epidemic is a national public-health emergency carries no extra money, but it "will help the government speed any available resources to communities, where the epidemic is playing out on the streets every day, and will eliminate some obstacles that stand in the way of providing assistance," Lenny Bernstein reports for The Washington Post.

One example: supplies of naloxone, branded as Narcan, which can stop an overdose in its tracks. "The emergency allows the federal government to speed more people and resources to the streets where naloxone is needed," Bernstein writes. "Acting Health and Human Services Secretary Eric Hargan could negotiate lower prices for government agencies. And he could put out model instructions for states and cities to issue 'standing orders' that make the antidote more readily available in pharmacies around the country."

The biggest need in rural areas is for treatment facilities, and greater access to them. "Barriers include a federal policy that prohibits Medicaid from paying inpatient facilities with more than 16 beds," Bernstein notes. "The emergency declaration would allow HHS to grant waivers to any state requesting one."

In an editorial, The Wall Street Journal says innovative approaches are needed: "Education for prescribers has improved in recent years but more is needed from within the profession. Beyond better prescribing, the problem gets complicated fast. FDA Commissioner Scott Gottlieb said in testimony at a House hearing this week that the agency is supporting the development of alternative painkillers with less addictive features. Another priority is expanding access to naloxone."

Congress should "consider the government’s role in allowing too-easy access to painkillers, particularly among society’s poor and vulnerable," the editorial says. "A 2016 Centers for Medicare and Medicaid Services bulletin noted that “'Medicaid beneficiaries are prescribed painkillers at twice the rate of non-Medicaid patients”' and are three to six times more at risk for overdose." In Medicare, "500,000 beneficiaries received more than 120 mg a day for at least three months—equivalent to 12 tablets a day of 10 mg Vicodin. That figure excludes patients with cancer or in hospice, who tend to need heavy pain meds. The only way to explain this cascade of pills is an epidemic of fraud."

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