The Obama Administration’s Final Say on Opioids

January 26, 2017

This month’s change in presidential administrations prompted some final words – and policy – from federal agencies on the subject of opioids.

First, the Centers for Medicare and Medicaid Services issued a controversial Opioid Misuse Strategy.  Then, the Food and Drug Administration’s commissioner outlined a call for continued action on opioid abuse, including better options for pain management.  And now, patients wait to see whether these ideas will hold under the new administration, and how President Donald Trump’s policies will balance the needs of patients in pain against the epidemic of abuse and overdose.

Opioid Misuse Strategy

CMS issued its strategy on January 5, acknowledging that the Medicare population has “among the highest and fastest-growing rates of diagnosed opioid use disorder.”  Medicaid recipients exhibit an even higher incidence.

The document surveys current efforts to address the national opioid misuse epidemic, focusing on CMS’ four priority areas:

1) Implementing more effective person-centered and population-based strategies

2) Expanding naloxone use, distribution, and access, when clinically appropriate

3) Expanding screening, diagnosis, and treatment of opioid use disorders

4) Increasing the use of evidence-based practices for acute and chronic pain management.

Those ideas were largely overshadowed, however, by the document’s suggestion that pharmacists should serve as watchdogs for physicians and patients.  In a strategy characterized as “Big Brother” by the pain community, CMS suggests that pharmacists should “identify prescribers with potentially illicit prescribing practices or beneficiaries (patients) who may be overusing opioids.”  The document explains that, “This information can be referred to health plans to investigate provider and beneficiary behaviors…”

Bob Twillman, PhD, of the Academy of Integrative Pain Management speculated that the scheme would foster distrust between pharmacists and physicians, rather than encouraging cooperation to ensure patients’ safe and appropriate treatment.

Final Words from Commissioner Califf

Two weeks later, outgoing FDA Commissioner Robert Califf, MD, had some final words of his own regarding the opioid crisis.  In an FDA Voice post, Dr. Califf lists the ways opioid abuse has impacted communities across the country and pinpoints several effective responses, such as the approval of abuse-deterrent opioid formulations and better product labeling.

“Efforts in this area must be continued and strengthened,” Dr. Califf argues, calling for “better” and “more holistic” ways to treat pain. “We need…to define the most effective non-medication approaches to pain and how to deliver them in a complex and financially constrained healthcare system,” Dr. Califf notes.  He also calls for more research funding on the issue of treating pain.

Both Califf’s remarks and CMS’ strategy highlight the challenges that continue to surround pain treatment and addiction in the United States.  Will access to safe, personalized and multimodal treatment materialize under President Trump’s administration?  Patients wait to see.

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