$1.3 trillion federal appropriations bill loaded with new health care spending Last Friday, President Trump signed a massive $1.3 trillion federal spending bill—the Omnibus Consolidated Appropriations Act of 2018. It is loaded with new spending for health care programs that were supported by the California Medical Association (CMA). Unfortunately, it did not include two bills that CMA was strongly promoting – the Affordable Care Act (ACA) market stabilization bill and a permanent solution for the nearly 700,000 Deferred Action for Childhood Arrivals program recipients. A brief summary of the federal spending bill is below. Bipartisan ACA Market Stabilization: CMA, the American Medical Association (AMA) and other physician groups strongly advocated to include the bipartisan ACA market stabilization bill in the omnibus spending package. Unfortunately, lawmakers could not reach a compromise. It would have funded for two-years the cost-sharing assistance that helps low-income families afford copayments and deductibles that President Trump eliminated in 2017. It would have also provided state waiver flexibility and reinsurance funding to cover high-cost, catastrophic cases. The Congressional Budget Office estimated that the bill would have reduced premiums by 20 percent in 2020. A compromise could not be reached because the Freedom Caucus insisted on placing abortion restrictions on the ACA plans in exchange for the two-year ACA stabilization bill. Opioids: The bill includes nearly $4 billion in new funding for prevention, treatment and law enforcement to address the opioid crisis. With the $6 billion in the Budget Act enacted by Congress in February, new 2018-2019 opioid funding totals $10 billion. The breakdown is as follows: $500 million for National Institutes of Health research on opioid addiction, development of opioid alternatives, pain management and addiction treatment. $27 million for Mental and Behavioral Health Education Training to recruit and train professionals in psychiatry, psychology, social work, marriage and family therapy, substance abuse prevention and treatment, and other areas. $105 million for the National Health Service Corps to expand access to opioid and substance use disorder treatment in rural and underserved areas. $100 million for a new Rural Communities Opioids Response Program to support prevention and treatment of substance use disorder in 220 counties and other rural communities identified by the Centers for Disease Control and Prevention (CDC) as being at high risk. $350 million (for a total of $475 million) to support CDC’s Opioid Prescription Drug Overdose Prevention activities. $10 million must be used to conduct a nationwide opioid education campaign to increase understanding of the epidemic and to increase prevention activities. Also requires CDC to promote the use of prescription drug monitoring programs (PDMP) and expand efforts to enhance the utility of state PDMPs to make them more interconnected, in real-time, and usable for public health surveillance and clinical decision making. CMA aggressively advocated for this provision to ensure that the federal government work with electronic health record (EHR) vendors to link EHRs to state PDMPs. $1 billion in new funding for State Opioid Response Grants $94 million for law enforcement and grants to combat opioid, heroin and other drug trafficking. $94 million to strengthen Food and Drug Administration (FDA) presence at international mail facilities and to fund equipment and technology to increase FDA capacity to inspect more incoming packages to detect illicit fentanyl. Gun Violence: The bill included $2.3 billion in funding associated with the STOP School Violence Act of 2018 to cover mental health services, security training and school safety programs to prevent gun violence. It also fully funds the FBI National Instant Criminal Background Check System. While CDC research promoting gun control is still prohibited, the Omnibus spending bill included a general clarification that there are no restrictions on general research related to gun violence. However, there was no funding appropriated for such research. Finally, it increased funding for the National Violent Death Reporting System to all 50 states to assist researchers and lawmakers. CMA continues to support California Senator Dianne Feinstein’s legislation that would ban assault weapons and high-capacity magazines, as well as efforts to require more extensive background checks and waiting periods. Mental Health Programs: Provides more than $2.3 billion in new funding for various mental health programs. Drug-Related Provisions: Physicians will continue to receive enhanced payments for the first few years a drug/biological is on the market to assist in the costs of adopting new drugs and technology. Graduate Medical Education: The Children’s Hospitals graduate medical education program received a $15 million funding increase, for a total of $315 million. Congress also provided an additional $15 million for the Rural Residency Program to expand the number of rural residency training programs with a focus on developing programs that can be self-sustainable. Other Notable Health Care Spending Increases: The National Institutes of Health received significant increase in funding to support research into Alzheimer’s disease, the Brain Initiative, the universal flu vaccine and antibiotic-resistance efforts. The CDC also received additional funding for diabetes programs. April 5, 2018 General Affordable Care Act, Drug Abuse, Federal Budget, Federal Legislative Advocacy, Firearms, Graduate Medical Education, Guns, Mental Health, Opioids 0 0 Comment Read More »
Free CME: Medication assisted treatment for opioid use disorders The Substance Abuse and Mental Health Services Administration is offering two free training sessions on the use of medication assisted treatment for opioid use disorders. The training, “The Effective Use of Medication Assisted Treatment in an Opioid Dependent Population,” will be held in Sacramento on July 18 and repeated in Orange County on July 20. Registration is first-come, first-served. Attendance is capped at 100 participants – you must register by July 3. Physicians can receive up to 7 continuing medical education (CME) credits. To register, click on the links below: Sacramento (July 18) Orange County (July 20) The California Medical Association (CMA) strongly supports efforts to increase access to much-needed medication-assisted treatment for opioid use disorders. For more information, visit CMA's safe-prescribing resource page at www.cmanet.org/safe-prescribing. There you will find: Resources on prescribing controlled substances safely and effectively to relieve pain, while simultaneously reducing the risk of prescription medication misuse, addiction and overdose. CMA’s white papers on prescribing opioids Links to relevant documents in CMA’s health law library Continuing medical education courses and webinars Current information on the state's prescription drug monitoring database June 22, 2017 General Continuing Medical Education, Drug Abuse, Medical Solutions to Drug Abuse, Opioids, CME 0 0 Comment Read More »
FDA wants opioid pulled from market due to risk of abuse Last week, the U.S. Food and Drug Administration (FDA) requested that Endo Pharmaceuticals remove its opioid pain medication, reformulated Opana ER (oxymorphone hydrochloride), from the market. After careful consideration, the agency is concerned that the benefits of the drug may no longer outweigh its risks. This is the first time the FDA has taken steps to remove a currently marketed opioid pain medication from sale due to the public health consequences of abuse. The FDA’s decision is based on a review of all available data and follows a March 2017 FDA advisory committee meeting where a group of independent experts voted 18-8 that the benefits of reformulated Opana ER no longer outweigh its risks. Opana ER was first approved in 2006 for the management of moderate-to-severe pain when a continuous, around-the-clock opioid analgesic is needed for an extended period of time. It was reformulated in 2012 in an attempt to make the drug resistant to physical and chemical manipulation for abuse by snorting or injecting. Postmarketing data has shown, however, a significant shift in the route of abuse of Opana ER from nasal to injection following the product’s reformulation. Injection abuse of reformulated Opana ER has been associated with a serious outbreak of HIV and hepatitis C, as well as cases of a serious blood disorder (thrombotic microangiopathy). “The abuse and manipulation of reformulated Opana ER by injection has resulted in a serious disease outbreak. When we determined that the product had dangerous unintended consequences, we made a decision to request its withdrawal from the market,” said Janet Woodcock, M.D., director of the FDA’s Center for Drug Evaluation and Research. “This action will protect the public from further potential for misuse and abuse of this product.” The FDA has requested that the company voluntarily remove reformulated Opana ER from the market. Should the company choose not to remove the product, the agency intends to take steps to formally require its removal by withdrawing approval. In the interim, the FDA is making health care professionals and others aware of the particularly serious risks associated with the abuse of this product. For more information about preventing opioid abuse, see the California Medical Association's safe prescribing resource page at www.cmanet.org/safe-prescribing. June 21, 2017 General Food and Drug Administration, Prescription Drugs, Drug Abuse, Opioids 0 0 Comment Read More »
DHCS gets federal grant to increase access to opioid treatment in California The California Department of Health Care Services (DHCS) has received a $90 million grant from the federal government to expand drug treatment services in California, primarily in counties and tribal communities that have higher rates of opioid-related overdose deaths. One key initiative will target those areas with an innovative approach to increase access to medications used to treat opioid addiction. DHCS will use a large portion of the grant from the U.S. Substance Abuse and Mental Health Services Administration to expand Californians’ access to medication-assisted treatment for opioid use disorders, particularly using buprenorphine. With more than 2.2 million people nationwide in 2015 who met the diagnostic criteria for an opioid use disorder, increasing appropriate access to life-saving addiction treatment services is one component of a balanced approach to addressing opioid-related morbidity and mortality rates. Treatment of opioid use disorder with medication-assisted treatment has been shown to be cost-effective, safe and successful when used appropriately. The California Medical Association (CMA) strongly supports efforts to increase access to much-needed medication-assisted treatment for opioid use disorders. DHCS also will use the grant to fund additional approaches to reduce opioid misuse, such as enhancing the wider distribution of naloxone, which can reverse the toxic effects of an opioid overdose; coordinating local coalitions to act together to reduce opioid abuse; and providing education and training to help reduce the stigma associated with addiction. For more information, visit CMA's safe-prescribing resource page at www.cmanet.org/safe-prescribing. There you will find: Resources on prescribing controlled substances safely and effectively to relieve pain, while simultaneously reducing the risk of prescription medication misuse, addiction and overdose. CMA’s white papers on prescribing opioids Links to relevant documents in CMA’s health law library Continuing medical education courses and webinars Current information on the state's prescription drug monitoring database May 22, 2017 General Drug Abuse, Medical Solutions to Drug Abuse, Opioids, Prescription Drugs 0 0 Comment Read More »
National Prescription Drug Take Back Day April 29, 2017 Saturday, April 29, 2017, is National Prescription Drug Take Back Day. On this day, hundreds of locations throughout California will be accepting and properly disposing of unused prescription drugs, including controlled substances. Proper disposal of unused prescription drugs helps prevent diversion and misuse associated with these medications. This one-day event will provide patients with free, anonymous collection of unwanted and expired medicines. In addition to providing a safe, convenient and responsible means of disposal, the event also aims to educate the general public about the potential for abuse of these medications. A significant component of the prescription drug abuse and diversion problem stems from misuse of unused drugs. According to the Substance Abuse and Mental Health Administration, over 71 percent of prescription pain medications are obtained from family and friends, and 5 percent took the medication from a friend or relative without asking. Physicians can take action by encouraging their patients to participate in Take Back Day. To find a collection site near your practice, click here. The California Medical Association (CMA) has produced a flyer to educate patients about proper disposal of prescription medication and National Prescription Drug Take Back Day, which can be placed in offices and waiting rooms. The American Medical Association Task Force to Reduce Opioid Abuse, of which CMA is a member, has also released a new resource that physicians can use to promote safe use, storage and disposal of opioids and other medications. These and other resources are available on CMA's safe prescribing webpage at www.cmanet.org/safe-prescribing. April 19, 2017 General Drug Abuse, Drug Prescribing, Prescription Drugs 0 0 Comment Read More »
No cost online buprenorphine waiver courses available Physicians must obtain a federal waiver if they wish to prescribe buprenorphine for treatment of opioid use disorder. Across the country, many people suffering from opioid use disorder are unable to access medication-assisted treatment for their condition due to a lack of nearby physicians with waivers to prescribe buprenorphine. California is no different. In 2013, there were only 1,460 waivered physicians actively prescribing buprenorphine in California, which amounts to approximately 3.9 physicians per 100,000 people, particularly impacting rural and underserved areas in the state. To help physicians obtain waivers, the American Osteopathic Academy of Addiction Medicine offers two online waiver trainings per month. The next scheduled west coast training, "Office-Based Treatment for Opioid Use Disorders," is Wednesday, September 28, 2016, from 5 to 9:30 p.m. PT. (To view the full schedule, click here.) The first half of the training is a 4.25-hour live webcast. The second half of the course is a 3.75-hour computer-based study. An examination on the computer study must be successfully completed within 30 days of the webinar to obtain a waiver for prescribing buprenorphine. With more than 2.2 million people nationwide last year who met the diagnostic criteria for an opioid use disorder, increasing appropriate access to live-saving addiction treatment services is one component of a balanced approach to addressing rising opioid-related morbidity and mortality rates. Treatment of opioid use disorder with opioid maintenance therapies has been shown to be cost-effective, safe and successful when used appropriately. To view register or view a list of all of the upcoming training opportunities, click here. September 22, 2016 General Opioids, Drug Abuse, Medical Solutions to Drug Abuse 0 0 Comment Read More »
Surgeon General enlists nation's physicians to help end opioid abuse The U.S. Surgeon General, Vivek Murthy, M.D., has asked the nation’s physicians to pledge their commitment to solving a health crisis facing America—opioid misuse, abuse and overdose. “We will educate ourselves to treat pain safely and effectively,” Dr. Murthy said in a letter to physicians. “We will screen our patients for opioid use disorder and provide or connect them with evidence based treatment…We can shape how the rest of the country sees addiction by talking about and treating it as a chronic illness, not a moral failing.” In the letter, Dr. Murthy announced the launch of a national campaign called Turn the Tide Rx, which is designed to educate and mobilize prescribers to take immediate action to stem opioid abuse. As part of the campaign, physicians are being asked to help #TurnTheTide with an online pledge to help combat opioid abuse at www.turnthetiderx.org. "As cynical as times may seem, the public still looks to our profession for hope during difficult moments. This is one of those times," wrote Dr. Murthy. The California Medical Association (CMA) supports a well-balanced approach to opioid prescribing and treatment that considers the unique needs of individual patients. CMA urges physicians to review the Medical Board of California's “Guidelines for Prescribing Controlled Substances for Pain,” which are intended to specifically address the use of opioids in the long-term treatment of chronic pain. The medical board guidelines also include references to special patient populations for other types of pain and across other treatment scenarios, as well as an extensive discussion about the nature and treatment of pain in general. CMA is also offering a webinar, “Understanding Pain and Safe Prescribing Guidelines,” intended for clinicians interested in the fundamentals of pain and improving their knowledge and skills in pain assessment and management, including safe prescribing and effective opioid treatment. The webinar will be on September 14, 2016, and continuing medical education credit is available. Registration is free for CMA members, and $99 for nonmembers. For more information, see CMA's safe-prescribing resource page at www.cmanet.org/safe-prescribing. There, you will find the most current information and resources on prescribing controlled substances safely and effectively to relieve pain, while simultaneously reducing the risk of prescription medication misuse, addiction and overdose. The resource page includes both of CMA’s white papers on prescribing opioids, links to CMA’s health law library resources on the topic, a listing of continuing medical education courses and webinars on pain management and safe prescribing, as well as the latest information on the state's prescription drug monitoring database. September 12, 2016 General Drug Prescribing, Opioids, Prescription Drugs, Public Health, Drug Abuse 0 0 Comment Read More »
Opioid bill passes in Congress, but remains unfunded Congress broke a months-long stalemate this past week with the Senate’s passage of the Comprehensive Addiction and Recovery Act (CARA), which authorizes the federal government to award state grants for opioid-related initiatives around education, prevention, treatment and recovery efforts. However, the efforts will not be fully realized until there are resources applied to fund the bill. The legislation authorizes, but doesn't appropriate funding, for programs to combat opioid misuse, in addition to increasing the availability of naloxone, a drug to treat overdoses. The medical community and the American Medical Association (AMA) applauded the vote, but called on Congress to authorize funding for it. “This legislation represents an important step in addressing the public health epidemic of opioid misuse,” said Patrice Harris, M.D., chair of the AMA Board of Trustees and chair of the AMA Task Force to Reduce Opioid Abuse. “But it will not be fully realized without new resources to support these programs and policies.” CARA, which also incorporates elements of the 18 opioid-related bills passed by the House in May, includes provisions to do the following: Authorize grants for opioid-related initiatives around education, prevention, treatment and recovery Improve prescription drug monitoring programs Expand access to the opioid overdose reversal drug naloxone Create training programs for providers to test co-prescription for at-risk patients Establish an interagency task force that will examine best practices for pain management and pain medication prescription Raise awareness and education around the safe care of infants born affected by illegal substances Require the Government Accountability Office to track and report on the capacity for inpatient and outpatient treatment for opioid use disorders July 18, 2016 General Drug Prescribing, Federal Legislation, Opioids, Prescription Drugs, Drug Abuse 0 0 Comment Read More »
Opioids: CMA publishes safe prescribing resources for physicians The California Medical Association (CMA) has published a members-only resource page to provide physicians with the most current information and resources on prescribing controlled substances safely and effectively to relieve pain, while simultaneously reducing the risk of prescription medication misuse, addiction and overdose. The page includes both of CMA’s white papers on prescribing opioids, links to CMA’s health law library resources on the topic, the Medical Board of California’s "Guidelines on Prescribing Controlled Substances for Pain," a listing of continuing medical education courses and webinars on pain management and safe prescribing, as well as the latest information on the state's prescription drug monitoring database (the Controlled Substance Utilization Review and Evaluation System, also known as CURES). Members can find the page at www.cmanet.org/safe-prescribing. June 8, 2016 General Drug Prescribing, Opioids, CURES, Drug Abuse, PDMP, Prescription Drugs 0 0 Comment Read More »
Senate passes opioid addiction treatment measure Last month, the U.S. Senate voted 94-1 to fund opioid education and prevention initiatives, improve treatment programs and expand the availability of the overdose prevention drug naloxone. The bill, known as the Comprehensive Addiction and Recovery Act (CARA; S 524), would increase opioid abuse and prevention education efforts to the public, veterans, and incarcerated individuals; expand the availability of naloxone; identify and treat incarcerated individuals (as well as develop alternatives to incarceration); expand drug take-back efforts and disposal sites for unwanted medications; and create prescription opioid and heroin treatment intervention programs and recovery support services. The U.S. House of Representatives is considering similar legislation (HR 953). The House version of the legislation, which was introduced in February 2015, currently has 92 cosponsors (75 Democrats and 32 Republicans). The House bill is still in committee, and none of the three committees to which it has been assigned has voted on it yet. The Senate bill is not fully funded, but Senate leaders vowed to find additional funding through the appropriations process. April 4, 2016 General Federal Legislation, Medical Solutions to Drug Abuse, Opioids, Drug Abuse 0 0 Comment Read More »
