The White House Opioid Summit
What is the focus now by the federal government to combat the opioid crisis and what plan is in place to help fight this crisis?
The two-and-a-half-hour opioid summit was kicked off by an opening with Melania Trump, followed by Kellyanne Conaway, Alex Azar, and Ben Carson all of whom were on the panel. The panel took the time to explain what their departments are doing to fight this crippling crisis. The departments that were a part of this summit were specifically: Health and Human Services (HHS), Housing and Urban Development (HUD), Department of Veterans Affairs (V.A.), Attorney General Jeff Sessions Department of Justice (DOJ), Department of Homeland Security (D.H.S.), and white house councilor Kellyanne Conaway. Each department took questions from the attendees who were mostly activist for different segments of the recovery industry and community.
Frontline activities of each agency and plans include law enforcement interdiction, treatment, and recovery, education, and prevention. A film was featured at the beginning of the summit after Melania gave her opening. Addiction the “Crisis next door” a film which featured stories of prominent families dealing with opioid overdose and their sentiments for others. Using the hashtag #notmykid the video stressed that this disease touched 1 out of 7 Americans from every social status, gender, religion, and race. Addiction does not discriminate, the video exaggerated, advising parents to talk to their children, pay attention to their spending habits and any abrupt change in personality.
They stressed the main focuses of this administration would be “prevention, treatments, and recovery”. This is where money and efforts to combat this crisis will be spent. HHS secretary Alex Azar said that his department and all should treat this subject as “a medical challenge not a moral failing.” Since October 26th, 2018, the day the opioid crisis was labeled a “public health emergency” the departments have been able to create and focus coordination and cooperation. Prescribing of opioids has dropped dramatically which is a part of the “prevention” aspect. Though three times the amount of pain medication is still prescribed compared to 1993 it is a considerable shift in the right direction from 2015, where six times the amount was being prescribed. The department of health and human services even had what they referred to as an opioid “codeathon” inviting students from Yale, Stanford, and Hopkins, as well as leading tech companies to assess risky opioid prescribing. The students helped assess and even created apps that can help prescriber prevent overprescribing of medications. HHS Secretary Alex Azar also notes that evidence-based treatments including medication-assisted treatments (M.A.T.) will help lead us in this fight against opioid addiction. Shortly after the declaration of emergency in December, HHS created a streamlined system for states to apply for waivers to support Medicaid substance abuse treatment providers. Alex Azar stated that 5 waivers have been submitted and approved so far. When he was attending an event with state Governors he asked, “why has there only been five waivers submitted!” He is committed to helping states get the resources their residence need in order to help attack the opioid epidemic in each state. Furthermore, two new FDA guidelines will help accelerate the amount of medication available to assist in opioid treatment, including a “depo-shot” which was approved this fall. Instead of only the Vivitrol shot being available (which is a 30-90-day naloxone shot) a Buprenorphine shot was created and approved. The Buprenorphine shot should have less negative side effects than the Vivitrol. Beyond new medications, the FDA will be using different guidelines to track the effectiveness of M.A.T. The new guidelines would judge success not by complete abstinence but through tracking “alternative endpoints”. For instance, those who have not returned to opioid use and if they have found out if the duration of use was shorter and relapse happens less often.
David Shulkin M.D., Secretary of the department of veteran affairs (V.A.), spoke about his commitment to helping in the fight to prevent, treat and sustain recovery from opiate abuse. The V.A. is the largest healthcare system in the country. In 2012 the V.A. started its “opioid safety initiative” and reduced the number of opioids prescribed by the V.A. to 41% which has effectively reduced the number of patients on opioids by 90%. Beyond prescribing fewer opiates the V.A. has integrated a “stepped approach” to pain management. This stepped approach has an acronym which is S.T.O.P.P.A.I.N. The “S” stands for “stepped model’ where physicians reach for the prescription pad last as oppose to the beginning. “T” is for treatment alternatives. This is using non-medical aspects and integrative medicine to treat patients as well as integrating M.A.T. to already addicted patients. “O” is ongoing monitoring usage using data. “P” for practicing guidelines which are also used by and with the department of defense as well all the center for disease control (CDC). The “P” in “P.A.I.N.” stands for prescription monitoring, using data. “A” is for academic detailing. Here pharmacists go to train and educate doctors on best practices. “I” is informed consent, the patient plays a part in taking these medications as well and will be informed that opiates are addictive along with any other warnings, they will be informed prior to being prescribed. “N” is for naloxone distribution. The V.A. distributes naloxone to local emergency rescue as well as its patients, which surely saves lives. The V.A. hopes that more health agencies will look at what they are doing and their 41% reduction in opioid usage and use some of the prevention and treatment methods to help other non V.A. patients. The V.A. has even made publicly available their opiate prescription rates on data.va.gov.
The panel proceeded to take questions from the audience, the first of whom a mother, who had lost her son to an opioid overdose. Questions were raised by industry professionals, proponents, and recovering addicts. Some questions included: prevention programs in schools, recovery residences, de-stigmatization, and different media campaigns for awareness. The panel responded to each and every question with sensible thought out answers. Anyone listening can tell there was a lot of thought and time put into practical solutions to address this opioid epidemic. HHS Secretary Alex Azar spoke about a historic budget that includes a one billion dollar grant to each state for opioid programs. Seventy-five-million in naloxone disbursement, to make the overdose-reversing drug more available and less expensive. A fifty-million dollar grant to for rural areas which are underserved, so treatment is available for every citizen no matter their geographical location. Communication campaigns to spread education as well as more community health centers to provide support after recovery is achieved. Before now, many facilities were unable to open a center with more than fifteen patients because of an old school provision to prevent the warehousing of mental health patients. I.M.D. previsions will be given waiver processes to grant permissions for more inpatient treatment centers and for those centers to be excluded from the I.M.D. for more Medicaid patients to receive treatment. More drug court programs to reduce prison recidivism, since many addicts are in prison not receiving the help they need.
The United States consumes over 90% of the opioids produced and we are only 5% of the population. The importance of what the government is doing for treatment response and addiction awareness is so important to stunting the growth of addiction and helping heal this hurting country with evidence-based approaches that work. Medication-assisted treatment will be more prevalent in the treatment world. More options will be available for people experiencing pain before a prescription is written. More funding will be available, more prevention, more support, and better data usage to protect our future youth and pain management clients. The government is adapting to our new world of medicine and addiction and making many changes to adapt correctly.