HHS Addressing Opioid Crisis

Senate Committee on Appropriations Subcommittee on Labor, Health and Human Services, Education and Related Agencies,  addressed the opioid crisis on December 5, 2017. Testimony was presented from top administrators within NIH, SAMHSA, and CDC.

Francis Collins, MD, PhD, Director, National Institutes of Health (NIH) www.nih.gov reports that NIH provides support for cutting-edge research on pain and opioid misuse, addiction, and overdose. The FY 2018 budget has requested more than $800 million to support the Department’s opioid investments.

To address pain, NIH supports the “Patient Reported Outcomes Measurement Information System” (PROMIS) which provides patient-reported outcome measurement tools to measure pain, fatigue, physical functioning, and emotional well-being.

NIH has developed the Federal Pain Research Strategy https://iprcc.nih.gov which includes the NIH-DOD-VA Pain Management Collaboratory program. NIH recently announced the availability of $81 million in research funding to implement cost-effective large-scale clinical research in military and veteran healthcare delivery. The focus is on non-pharmacologic approaches to pain management.

According to testimony from Elinore McCance-Katz, MD, PhD, Assistant Secretary for Mental Health and Substance Use, within the Substance Abuse, and Mental Health Services Administration (SAMHSA) https://www.samhsa.gov, “The most alarming issue related to the opioid crisis is the increase in overdose deaths.”

SAMHSA supports several grant program related to the Opioid Crisis. Presently, SAMHSA administers the “Opioid State Targeted Response” (STR) grants, a two year program authorized by the 21st Century Cures Act. The program has requested $500 million for FY 2018 to allow the states to focus on areas with the greatest needs.

SAMHSA’s “Medication Assisted Treatment for Prescription Drug and Opioid Addiction” (MAT-PDOA) program provides grants to states with the highest rates of treatment admissions for opioid addiction. In September 2017, SAMHSA awarded $35 million over three years in additional MAT-PDOA grants to six states.

SAMHSA is providing $11 million per year in grants to prevent prescription drug/opioid overdose related deaths in 12 states. These funds are being used to train first responders on emergency medical care to be rendered in an overdose situation.

SAMHSA, is also working hard to strengthen public health data and reporting and has developed the “National Survey on Drug Use and Health” (NSDUH). This survey provides key national and state level data on a variety of substance use and mental health topics including opioid misuse. The data has been used to track historical and emerging trends in not only opioid misuse, but in addition, includes geographic and demographic variabilities.

“CDC https://www.cdc.gov has been working hard to understand the extent of the problem and find solutions”, according to Debra Houry MD, M.P.H., Director, for the National Center for Injury Prevention and Control at CDC.

According to Dr. Houry, “CDC is using data to help states build capacity to monitor the scope of the epidemic and to better focus on prevention activities. CDC’s “Overdose Prevention in States (OPIS) program provides resources and scientific support to 45 states and Washington D.C. through three programs.”

The first two CDC programs, the “Prescription Drug Overdose: Prevention for States” and the “Data-Driven Prevention Initiative” provide states with the resources, tools, and technical expertise to execute and evaluate prevention strategies.

CDC also operates the “Enhanced State Opioid Overdose Surveillance” program which funds 32 states and Washington D.C. This program is unique is that the program uses emergency department and emergency medical services data to track and analyze morbidity data. The data is used to establish an early warning system to detect sharp increases or decrease in non-fatal overdoses.

CDC created the “Guideline for Prescribing Opioids for Chronic Pain” and is using technology to develop an Opioid Guideline mobile app containing all of the Guidelines, recommendations, a morphine milligram equivalent calculator, and an interactive interviewing feature to help providers prescribe.

CDC funds the Johns Hopkins Injury Control Research Center which is studying how to reduce injured patients risk for opioid misuse by using mobile health technology. CDC also funds the Carolinas Medical Center in Charlotte North Carolina, to enable providers to compare changes in prescribing behaviors when providers are presented with electronic alerts on potential misuse or abuse of opioids.

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