White House Initiative Addresses Opioid Crisis to Reduce Overdose Deaths
To identify individuals with opioid use disorder, improved surveillance is proposed, and treatment is recommended.
On October 30, 2017, the Clinton Foundation's Health Matters Initiative held a panel event at the Johns Hopkins Bloomberg School of Public Health for the release of a report co-written by the two organizations, titled, “The Opioid Epidemic – From Evidence to Impact.”1 This evidence-based document was made public 4 days after President Trump declared the opioid crisis a public health emergency. In recent years, the Clinton Foundation has been actively involved in the fight against opioid addiction in the United States. In 2012, the organization launched an opioid overdose and substance use prevention campaign. As part of this effort, the foundation, in partnership with Adapt Pharma, distributed doses of naloxone hydrochloride to several campuses across the country — initially free of charge — with the goal of “provid[ing] a predictably affordable supply of naloxone to community groups, public safety organizations, and schools and universities, creating a window of opportunity for the naloxone distribution field to scale over the next five years.”
The event at Johns Hopkins was introduced by former President Bill Clinton, who also moderated the first panel of speakers. “In many locations, community health places have been allowed to atrophy,” he noted. “The good news is, this is the first epidemic where we act like grown-ups and treat it like a public health problem,” he continued, adding, “The bad news is that it is a public health problem [for which] there is an inadequate response, not properly coordinated with law enforcement [and other entities].”
President Clinton announced the 3 key aspects of the initiative led by his foundation. The first seeks to address the stigma associated with substance abuse, which, according to President Clinton, plays a major role in individuals refusing to ask for help. In partnership with the nonprofit Facing Addiction, the Clinton Foundation will strive to empower affected individuals to overcome perceived stigma. “It is a health problem,” remarked President Clinton. “We need the same methods to go out everywhere.” Another major aspect of his foundation's initiative lies in the promotion of cooperation among law enforcement, criminal justice, and the healthcare community. These entities share similar goals, he noted, yet, they do not cooperate. He emphasized the lack of a comprehensive strategy allowing effective allocation of funds dedicated to addressing the epidemic, and said the foundation strives to work with law enforcement agencies. Last, the former President announced that the Clinton Health Matters Initiative would work with several communities in its effort to combat the crisis. “We are going to do more to build up coalitions of stakeholders, [and aim to get] everyone involved to fight together,” he declared.
Clinton Foundation Report Recommendations
The report provides 49 recommendations under 10 topic areas, half of which aim to improve the safe use of prescription opioids, the remaining seeking to identify and treat individuals with opioid use disorders. With these recommendations, the report's authors seek to “provide guidance for those who are searching for solutions to address the unacceptable toll of opioid-use disorders in the United States as well as ways to reduce prescription opioid overuse and to maximize the quality of care for those with pain,” and is geared to all parties and individuals involved, from clinicians and patients, to law enforcement officials and policymakers. Measures aimed at optimizing prescription drug monitoring programs (PDMPs) and at standardizing clinical guidelines are offered to improve the safe use of prescription opioids. To identify individuals with opioid use disorder, improved surveillance is proposed, and treatment is recommended through increased naloxone availability and the “expansion of harm reduction strategies.”
Find the full Clinton Foundation/Bloomberg report here.
White House Recommendations
The report, released on November 1, 2017, by the President's Commission on Combating Drug Addiction and the Opioid Crisis, provides 56 recommendations dealing with opioid addiction prevention (through guidelines and regulations for opioid prescriptions, improvements of current PDMPs, supply reduction, and adequate judicial framework), treatment for opioid addiction, opioid overdose and recovery, as well as priorities for related research and development.2 Although the Commission urged for federal support to the states “where the battle is happening every day… [through the creation of] uniform block grants [that] would allow more resources to be spent on administering lifesaving programs,” no figure is mentioned.
Addiction Policy Expert's Take on the White House Initiative
Clinical Pain Advisor interviewed Keith Humphreys, PhD, professor and section director for mental health policy in the department of psychiatry and behavioral sciences at Stanford University, California. Dr Humphreys served as senior policy advisor at the White House Office of National Drug Control Policy in the Obama Administration, during which time he actively participated in the formulation of policies dealing with addiction.
Clinical Pain Advisor: How might planned cuts to the Affordable Care Act (ACA) and Medicaid affect the administration's efforts to address the opioid epidemic?
Dr Humphreys: Medicaid is now the largest public payer for addiction treatment in the United States, and the ACA provides further support for addiction treatments by defining it as an essential healthcare benefit for health insurance plans sold on state exchanges. Repealing the ACA and/or Medicaid expansion would thus deprive millions of addicted Americans of treatment access.
Clinical Pain Advisor: Should the opioid crisis have been declared a national vs public health emergency so as to benefit from greater and faster funding?
Dr Humphreys: The President was elected a year ago, so funding could have been made available much more quickly if he had worked with Congress at any previous point to pass a bill providing monies to address the crisis. The emergency declaration opens up the Public Health Emergency Fund, but it has only $57,000 in it at the moment — that's less than a dollar per overdose death this year.
Clinical Pain Advisor: How would funds best be allocated?
Dr Humphreys: The best policy would be for Medicaid expansion to occur in all states as a way to expand treatment access. It would also help to invest in reducing overprescribing of opioids — despite the recent decrease of 15%, the US still has a per capita rate 5 times that of other developed countries.
Clinical Pain Advisor: What set of policies would best address the issue?
Dr Humphreys: Improved training of doctors in pain management, expanded addiction treatment and access to the overdose rescue drug naloxone, and tighter regulation of the pharmaceutical industry.
Clinical Pain Advisor: Any other point you would like to address?
Dr Humphreys: Building a wall on the Mexican border to stop opioids makes no sense when US doctors write [more than] 200 million opioid prescriptions a year.
- Johns Hopkins Bloomberg School of Public Health and the Clinton Foundation's Clinton Health Matters Initiative. The Opioid Epidemic – From Evidence to Impact. Available at: https://www.jhsph.edu/events/2017/americas-opioid-epidemic/report/2017-JohnsHopkins-Opioid-digital.pdf. October 2017. Accessed November 1, 2017.
- The President's Commission on Combating Drug Addiction and the Opioid Crisis. Report. Accessed: November 1, 2017.