Dr. Leana S. Wen: Five Issues for the White House Opioid Commission to Address

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Yesterday, the President’s Commission on Combating Drug Addiction and the Opioid Crisis issued its draft interim report on fighting the national opioid crisis.

I support the draft recommendations included in the Commission’s report, especially the call for declaring a national state of emergency. Imagine if there were hundreds of people dying from a disease such as Ebola or a natural disaster every day—there would be no question about the necessity of such a declaration.

I am also heartened to see that the recommendations follow the best available evidence, including support for medication-assisted treatment, which has been scientifically shown to be effective in treating opioid addiction. This is similar to the use of insulin for treating diabetes, and reinforces what we know in medicine to be true; addiction is a disease, treatment exists, and recovery is possible.

In completing this report, I urge that the Commission focuses on the following five issues: 

First, the Commission must call attention to the pervasive stigma that surrounds the disease of addiction and the importance of combating stigma with science. This can be done through public education initiatives such as Baltimore's Don’t Die campaign and our focus on hiring people who are in recovery to be outreach workers and case managers.

Second, the Commission must advocate for taking all necessary steps to expand health insurance. This includes protecting Medicaid, which covers 1 in 3 patients who have a substance use disorder, as well as ensuring that essential health benefits covering addiction and mental health treatment remain as part of every insurance plan. There should also be coverage for other wraparound services that are critical for treating addiction, such as supportive housing and reimbursement for peer recovery specialists. Block grants are helpful, but cannot be depended on for treatment of such a widespread disease. No other disease is treated through grants alone.

Third, the Commission must highlight and encourage the development of innovations in cities and counties that are on the frontlines of the opioid epidemic. In the last two years, Baltimore City’s blanket prescription for naloxone, accompanied by targeted outreach efforts, have resulted in more than 1,000 lives saved by everyday residents. Unfortunately, a shortage of funding has forced us to ration this life-saving antidote. We look to the federal government to assist us through aggressive price negotiation. In addition, every one of our city hospitals conducts screening, brief intervention and referral to treatment, and we are starting a 24/7 crisis center—an ER for patients with substance use disorders. Such successful efforts are limited by funding constraints, but their success should be rewarded through innovative funding mechanisms with the intention to be scaled across the country.

Fourth, the Commission must go beyond incentivizing physicians to become more judicious with opioid prescribing—they should also be required to integrate substance use disorder treatment into their medical practice. This includes requiring all eligible physicians to obtain the waiver to prescribe buprenorphine and approving state-level pilots for integrating primary care and behavioral health treatment. Medication-assisted treatment should be offered not only in existing facilities that offer such treatments, but it should be the standard of care for all treatment centers that offer addiction services.

Finally – and most importantly – the Commission must specifically state how much more funding the federal government should put forth to treat this national epidemic once and for all. Rhetoric alone is not enough, and the Commission should not allow for this report to add to the collection of reports that have already been unequivocal in calling for additional funding. The science is clear. We know what works to overcome this crisis. We just need the resources and the will to get there.

Dr. Leana Wen is the Baltimore City Health Commissioner. Twitter: @DrLeanaWen and @BMore_Healthy.

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