Progress on the opioid crisis

Published 8:27 am Monday, February 19, 2018

Families all across the nation are struggling to cope with the devastating impact the ongoing opioid epidemic is having on their communities. Recent studies have shown that every day, at least three Tennesseans die because of opioid-related overdoses. In fact, last December the Centers for Disease Control and Prevention (CDC) released a report that highlighted life expectancy in the U.S. had fallen for the second year in a row, a significant factor being the rash of opioid overdose deaths. The ongoing and widespread abuse of opioid prescriptions in Tennessee, and around the nation, has made it clear that drastic measures need to be taken to prevent this epidemic from taking even more lives. That said, the opioid crisis affects Americans from all walks of life no matter their race, gender, socioeconomic status, geographic location or background. According to the Tennessee Department of Health, drug overdose deaths increased from 1,451 in 2015 to 1,631 in 2016. In 2015, there were 13,034 nonfatal overdose outpatient visits recorded across our state. Deaths related to non-clinical fentanyl use increased 74 percent from 2015 to 2016. These numbers are staggering, and they are a clear indication of the need to combat this epidemic.
Last year, President Donald Trump declared the opioid crisis a “national public health emergency,” which allows for additional federal resources to go toward combating the opioid epidemic. To this end, last week the Bipartisan Budget Act allocated an additional $6 billion over the next two years to bolster the ongoing fight against opioid addiction and substance abuse. The additional resources are expected to fund grants, prevention programs and law enforcement efforts in vulnerable communities across the country.
In 2016, one of our most significant accomplishments was passing the Comprehensive Addiction and Recovery Act (CARA). CARA authorizes federal resources to assist states, first responders, local law enforcement officials and health care professionals in addressing opioid abuse in their communities. Just last month, Tennessee Governor Bill Haslam unveiled TN Together, a $30 million proposal to help fight the opioid epidemic in Tennessee. The plan would assist low income addicts in paying for recovery programs, add recovery specialists to hospitals and provide naltrexone — used to help men and women suffering from the side effects of withdrawal — to jails and drug treatment courts around the state. TN Together will also provide Tennessee Highway Patrol Officers with naloxone, a medication that reverses opioid overdoses and has been proven to save many lives.
The opioid crisis is unlike many of our previous battles with addictive substances because it involves legal prescription drugs, so it is going to require us to think of new ways to ensure people never get addicted in the first place. As a doctor, I hope to facilitate a broader conversation about how we treat pain in our country. For so long, the craziest thing to me was that doctors’ Medicare payments were tied to how satisfied patients were in how their pain was managed. If a patient reported that they were in pain due to a medical procedure and the physician didn’t address it to their satisfaction, then the physician’s payment would have been cut. This incentivized overprescribing of opioids based on a subjective standard. Fortunately, because of the reforms we worked on, we ended this practice. Doctors must still monitor patients’ pain, but they no longer have to fear being denied reimbursement because opioids weren’t prescribed.
We also know that too many patients become addicted because they receive initial prescriptions of opioids that exceed a reasonable length. I think we have a responsibility as providers to ensure patients’ pain is managed in a way that does not put them at risk for addiction and long-term opioid use if there are other ways to adequately manage pain. This is why I introduced bipartisan legislation with my colleagues Reps. Ann Kuster (D-NH) and Tom MacArthur (R-NJ) to limit an initial post-acute opioid prescription to no more than a 10-day supply. My legislation, the Opioid Addiction and Prevention Act, would still allow states to establish more limited timeframes for these prescriptions and would not have any impact on patients who use opioids for the regular management of chronic pain — including patients who have been diagnosed with cancer or are receiving end-of-life treatment. A recent study by the CDC showed that 13.5 percent of patients who were given a prescription for eight days or longer were still using opioids a year later, and 30 percent of patients who were given a prescription of a month were still using a year later. To this end, Governor Haslam has proposed limiting the initial amount of opioids prescribed to new patients to no more than a five-day supply, which is the timeframe at which the CDC study showed a sharp increase in the risk for long-term use. Clearly, the more vigilant we are in the early days of an opioid prescription, the better the chance we will have of preventing addiction.
This issue is a serious public health crisis and threat to the nation, and too important to ignore or let politics prevent us from adequately addressing the problem. If you live in the state of Tennessee and are suffering from substance abuse and need immediate help, please call the Tennessee Redline at 1-800-889-9789.
As always, feel free to contact my office if I can be of assistance to you or your family.

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