Will The Opioid Epidemic Be Preventable and Reversible?
On October 26, 2017, the Trump Administration declared the opioid epidemic a public health emergency. While the announcement is a step in the right direction, the lack of federal funding and administrative support may create an environment of public frustration. Congress should immediately allocate money by using the Public Health Emergency Fund, and other means.
“No part of our society — not young or old, rich or poor, urban or rural — has been spared this plague of drug addiction and this horrible, horrible situation that’s taken place with opioids,” Mr. Trump said. “This epidemic is a national health emergency,” said Mr. Trump.
Unfortunately, this announcement falls far short of the promise to devote significant public resources to combat the epidemic. However, there are two potentially positive avenues to deliver resources by using the Public Health Emergency Fund, and waiving the Medicaid Institutions for Mental Diseases (IMD) exclusion.
The Public Health Emergency Fund is used to respond to public health emergencies like the one announced yesterday. Since the money takes months to reach state and local governments, Congress should appropriate adequate funds before the end of the year for use in 2018. There is virtually no money allocated for this purpose now.
Currently, the Medicaid Institutions for Mental Diseases (IMD) exclusion in section 1905(a)(B) of the Social Security Act prohibits the use of federal Medicaid financing for care provided to most patients in mental health and substance use disorder residential treatment facilities larger than 16 beds. Yesterday’s announcement waives this exclusion, which may help states fund additional resources to assist the most vulnerable people with opioid addictions.
The war against over prescribed opioids for chronic pain should not be underestimated and will require an integrated societal focus and substantial funding. Everyone including patients, families, providers, pharmaceutical companies and regulators need to address the issue in constructive ways. At least now, the federal government has recognized the epidemic as a national emergency. To make progress to prevent and reverse the epidemic, adequate future funding of strategic case management clinics is necessary.
There are several positive examples of clinics around the country offering chronic pain management. One such example is the Mayo Clinic's Pain Rehabilitation Center (PRC) which is staffed with an integrated team of health care professionals trained in many areas, including pain medicine, physical therapy, psychology, occupational therapy, biofeedback and nursing. The program “assists participants in eliminating the use of pain medications. Individuals who are not taking pain medications also are welcome to attend the PRC, and they make up a large proportion of participants in the program.” Reportedly, over half the participants in this program are addicted to opioids.