ABCDE
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The President's Commission
(56 recommendations)
Color & DescriptionCategoryStatus Change
2018 > 2020
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Last Edit: July 2020
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1
4
Pres. Comm. #1:
Congress and the Administration should increase block grant funding for opioid-related and substance use disorder (SUD)-related activities in the states.
Green - Some Considerations National Coordination
5
2
6
Pres. Comm. #2:
The Office of National Drug Control Policy (ONDCP), through support from Health & Human Services and the Department of Justice, should establish a coordinated system for tracking all federally- funded initiatives.
Yellow - Warning, Caution Ahead National Coordination
7
3
8
Pres. Comm. #3:
Congress should fund implementation of ONDCP review for every federal program and mandate federal and state cooperation.
Yellow - Some Coordination National Coordination
9
4
10
Pres. Comm. #4:
The Department of Education should collaborate with states (Dept. of Ed) on student assessment programs, such as Screening, Brief Intervention, and Referral to Treatment (SBIRT) - to identify at-risk youth who may need treatment.
Yellow - Some momentum, needs more resultsTreatment & RecoveryRed > Yellow
11
5
12
Pres. Comm. #5:
The Administration should fund and collaborate with private sector and non-profit partners to design a wide reaching, multi- platform national campaign addressing the hazards of substance use, the danger of opioids, and stigma.
Green - CompletedPublic Awareness; Family Outreach & Support
13
6
14
Pres. Comm. #6:
Various federal agencies should develop model statutes, regulations, and policies with stakeholders that ensure informed patient consent prior to an opioid prescription for chronic pain.
Green - CompletedPrescription MedicineYellow > Green
15
7
16
Pres. Comm. #7:
Health & Human Services (HHS) should coordinate the development of a national curriculum and standard of care for opioid prescribers - to supplement the Centers for Disease Control (CDC) guideline targeted to primary care physicians.
Green - CompletedPrescription MedicineYellow > Green
17
8
18
Pres. Comm. #8:
Federal agencies should collect participation data on prescribing patterns, matched with participation in continuing medical education (CME) data to determine effectiveness and to share with clinicians, stakeholders, and state licensing boards.
Orange - UnknownPrescription Medicine
19
9
20
Pres. Comm. #9:
The Administration should develop a model training program to be disseminated at all levels of medical education on screening for substance use and mental health status to identify at-risk patients.
Green - Education Organizations LeadingPrescription Medicine
21
10
22
Pres. Comm. #10:
Congress should amend the Controlled Substances Act to allow the Drug Enforcement Agency (DEA) to require that all prescribers desiring to be relicensed to prescribe opioids show participation in an approved Continuing Medical Education (CME) on opioid prescribing.
Yellow - State Progress Prescription MedicineRed > Yellow
23
11
24
Pres. Comm. #11:
Health and Human Services, Department of Justice, Drug Enforcement Agency, Office of National Drug Control Policy, and pharmacy associations should train pharmacists on best practices to evaluate legitimacy of opioid prescriptions and not penalize them for denying inappropriate prescriptions.
Orange - UnknownPrescription Medicine
25
12
26
Pres. Comm. #12:
The Administration should support the Prescription Drug Monitoring Program (PDMP) Act and mandate that states receiving grant funds comply with PDMP requirements, including data sharing.
Yellow - Some Initiatives In PlacePrescription Medicine
27
13
28
Pres. Comm. #13:
Federal agencies should mandate PDMP checks and consider amending requirements under the Emergency Medical Treatment and Labor Act (EMTALA), which requires hospitals to screen and stabilize patients in an emergency department, regardless of insurance status or ability to pay.
Red - Very UnlikelyPrescription Medicine
29
14
30
Pres. Comm. #14:
PDMP data integration with electronic health records, overdose episodes, and substance use disorder-related decision support tools for providers is necessary to increase effectiveness.
Orange - Nonspecific/Non-Trackable Prescription Medicine
31
15
32
Pres. Comm. #15:
The Office of National Drug Control Policy and the Drug Enforcement Agency (DEA) should increase electronic prescribing to prevent diversion and forgery. Revise (DEA) regulations regarding electronic prescribing for controlled substances.
Yellow - Some Effort But Not EnoughPrescription Medicine
33
16
34
Pres. Comm. #16:
The Federal Government should work with states to remove legal barriers and ensure Prescription Drug Management Programs (PDMP) incorporate available overdose/naloxone deployment data, including the Department of Transportation’s (DOT) Emergency Medical Technician (EMT) overdose database. It is necessary to have overdose data/naloxone deployment data in the PDMP to allow users of the PDMP to assist patients.
Yellow - Long Way to GoPrescription MedicineRed > Yellow
35
17
36
Pres. Comm. #17:
Communities should utilize Take Back Day to inform the public about drug screening and treatment services. Hospitals/clinics and retail pharmacies should become year-round authorized collectors and explore the use of drug deactivation bags.
Green - Steady ProgressPrescription Medicine
37
18
38
Pres. Comm. #18:
The Center for Medicare & Medicaid Services (CMS) should remove pain survey questions entirely on patient satisfaction surveys so that providers are never incentivized for offering opioids to raise their survey score. The ONDCP and Health & Human Services should establish a policy to prevent hospital administrators from using patient ratings from CMS surveys improperly.
Yellow - Slow ProgressFull-Spectrum Prevention
39
19
40
Pres. Comm. #19:
CMS should review and modify rate-setting policies that discourage the use of non-opioid treatments for pain, such as certain bundled payments that make alternative treatment options cost prohibitive for hospitals and doctors, particularly those options for treating immediate post-surgical pain.
Yellow - Attempts have fallen shortFull-Spectrum Prevention
41
20
42
Pres. Comm. #20:
The Federal Government should strengthen data collection activities enabling real-time surveillance of the opioid crisis at the national, state, local, and tribal levels.
Yellow - Some Momentum, Needs Improvement Law Enforcement & Medical Response
43
21
44
Pres. Comm. #21:
The Federal Government should work with the states to develop and implement standardized rigorous drug testing procedures, forensic methods, and use of appropriate toxicology instrumentation in the investigation of drug-related deaths.
Yellow - Slow MovementLaw Enforcement & Medical Response
45
22
46
Pres. Comm. #22: Reinstituting the Arrestee Drug Abuse Monitoring (ADAM) program and the Drug Abuse Warning Network (DAWN) to improve data collection and provide resources for other promising surveillance systems.Yellow - Slow ProgressLaw Enforcement & Medical Response
47
23
48
Pres. Comm. #23:
Enhance federal sentencing penalties for the trafficking of fentanyl and fentanyl analogues.
Green - In MotionLaw Enforcement & Medical Response
49
24
50
Pres. Comm. #24:
Federal law enforcement should target Drug Trafficking Organizations and other individuals who produce and sell counterfeit pills, including including those sold via the internet.
Green - DEA Targeting Pill Presses & Dark WebLaw Enforcement & Medical Response
51
25
52
Pres. Comm. #25:
Congress should amend the law to give the DEA the authority to regulate the use of pill presses/ tableting machines with requirements for the maintenance of records, inspections for verifying location and stated use, and security provisions.
Orange - Need Funding and AuthorityLaw Enforcement & Medical Response
53
26
54
Pres. Comm. #26:
The U.S. Customs and Border Protection and the U.S. Postal Service should use additional technologies and drug detection canines to expand efforts to intercept fentanyl (and other synthetic opioids) in envelopes and packages at international mail processing distribution centers.
Yellow - Logistical ChallengeLaw Enforcement & Medical Response
55
27
56
Pres. Comm. #27:
Congress and the Federal Government should use advanced electronic data on international shipments from high-risk areas to identify international suppliers and their U.S.-based distributors.
Yellow - Doesn't Ensure ComplianceLaw Enforcement & Medical Response
57
28
58
Pres. Comm. #28:
Congress should support the Synthetics Trafficking and Overdose Prevention (STOP) Act and the Federal Government should work with the international community to implement the STOP Act in accordance with international laws and treaties.
Yellow - Good First StepLaw Enforcement & Medical Response
59
29
60
Pres. Comm. #29:
Coordinate federal and Drug Enforcement Agency’s (DEA) effort to prevent, monitor, and detect the diversion of prescription opioids for illicit distribution or usage.
Green - Significant ProgressLaw Enforcement & Medical Response
61
30
62
Pres. Comm. #30:
The White House should develop a national outreach plan for the Fentanyl Safety Recommendations for First Responders. The Federal Government should partner with Governors and state fusion centers to develop and standardize data collection, analytics, and information-sharing related to first responder opioid-intoxication incidents.
Green - Solutions on HandLaw Enforcement & Medical Response
63
31
64
Pres. Comm. #31:
Health & Human Services (HHS), Center for Medicare & Medicaid Services (CMS), Substance Abuse and Mental Health Services Administration (SAMHSA), the Veterans Administration (VA), and other federal agencies should incorporate quality measures that address addiction screenings and treatment referrals. HHS should review the scientific evidence on the latest opioid use disorder (OUD) and SUD treatment options and collaborate with the U.S. Preventive Services Task Force (USPSTF) on provider recommendations.
Green - Some ProgressPrescription Medicine
65
32
66
Pres. Comm. #32:
Adopt process, outcome, and prognostic measures of treatment services as presented by the National Outcome Measurement and the American Society of Addiction Medicine (ASAM).
Yellow - Some ProgressTreatment & Recovery
67
33
68
Pres. Comm. #33:
HHS, The Centers for Medicare and Medicaid Services (CMS), the Indian Health Service (IHS), Tricare, the Drug Enforcement Agency (DEA), and the Veterans Administration (VA) should remove reimbursement and policy barriers to SUD treatment, such as patient limits, that limit access to any forms of FDA-approved medication-assisted treatment (MAT), counseling, inpatient/residential treatment, and other treatment modalities, particularly fail-first protocols and frequent prior authorizations. All primary care providers employed by the above- mentioned health systems should screen for alcohol and drug use, and provide treatment within 24 to 48 hours, directly or through referral.
Yellow - UncoordinatedTreatment & Recovery
69
34
70
Pres. Comm. #34:
Health and Human Services (HHS) review and modify rate-setting (including policies that indirectly impact reimbursement) to better cover the true costs of providing SUD treatment, including inpatient psychiatric facility rates and outpatient provider rates.
Yellow - Needs More WorkTreatment & Recovery
71
35
72
Pres. Comm. #35:
Because the Department of Labor (DOL) regulates health care coverage provided by many large employers, the Commission recommends that Congress provide DOL increased authority to levy monetary penalties on insurers and funders, and permit DOL to launch investigations of health insurers independently for parity violations.
Yellow - UncoordinatedTreatment & Recovery
73
36
74
Pres. Comm. #36:
Federal and state regulators should use a standardized tool that requires health plans to document and disclose their compliance strategies for non-quantitative treatment limitations (NQTL) parity. HHS, in consultation with DOL and Treasury, should review clinical guidelines and standards to support NQTL parity requirements.
Yellow - UncoordinatedTreatment & Recovery
75
37
76
Pres. Comm. #37:
The Commission recommends the National Institute on Corrections (NIC), the Bureau of Justice Assistance (BJA), the Substance Abuse and Mental Health Services Administration (SAMHSA), and other national, state, local, and tribal stakeholders use medication-assisted treatment (MAT) with pre-trial detainees and continuing treatment upon release.
Red - Needs Funding, Culture and Attitude ChangeTreatment & Recovery
77
38
78
Pres. Comm. #38:
The Department of Justice (DOJ) should broadly establish federal drug courts within the federal district court system in all 93 federal judicial districts. States, local units of government, and Indian tribal governments should apply for drug court grants established by 34 U.S.C. § 10611. Individuals with a substance use disorder (SUD) who violate probation terms with substance use should be diverted into drug court, rather than prison.
Yellow - Need More GrowthLaw Enforcement & Medical Response
79
39
80
Pres. Comm. #39: The federal government should partner with appropriate hospital and recovery organizations to expand the use of recovery coaches, especially in hard-hit areas. Insurance companies, federal health systems, and state payers should expand programs for hospital and primary case- based SUD treatment and referral services.Green - Progress at the State Level Treatment & Recovery
81
40
82
Pres. Comm. #40:
The Commission recommends the HRSA prioritize addiction treatment knowledge across all health disciplines.
Yellow - Slow ProgressTreatment & Recovery
83
41
84
Pres. Comm. #41:
The Commission recommends that federal agencies revise regulations and reimbursement policies to allow for substance use disorder treatment via telemedicine.
Yellow - Progress, But Gaps Still ExistPrescription Medicine
85
42
86
Pres. Comm. #42:
The Commission recommends further use of the National Health Service Corps to supply needed health care workers to states and localities with higher than average opioid use and abuse.
Green - Steady Funding Prescription Medicine
87
43
88
Pres. Comm. #43:
The National Highway Traffic Safety Administration (NHTSA) should review its National Emergency Medical Services (EMS) Scope of Practice Model with respect to naloxone, and disseminate best practices for states that may need statutory or regulatory changes to allow Emergency Medical Technicians (EMT) to administer naloxone, including higher doses to account for the rising number of fentanyl overdoses.
Green - States Have AnsweredLaw Enforcement & Medical Response
89
44
90
Pres. Comm. #44:
The Commission recommends HHS implement naloxone co-prescribing pilot programs to confirm initial research and identify best practices. ONDCP should, in coordination with HHS, disseminate a summary of existing research on co-prescribing to stakeholders.
Yellow - Needs More EffortPrescription Medicine
91
45
92
Pres. Comm. #45:
The Department of Health and Human Services (HHS) should develop new guidance for Emergency Medical Treatment and Labor Act (EMTALA) compliance with regard to treating and stabilizing substance use disorder (SUD) patients and provide resources to incentivize hospitals to hire appropriate staff for their emergency rooms.
Red - Treatment ShortageLaw Enforcement & Medical Response
93
46
94
Pres. Comm. #46:
The Commission recommends that HHS implement guidelines and reimbursement policies for Recovery Support Services, including peer to peer programs, jobs and life skills training, supportive housing, and recovery housing.
Green - On The Right Track Treatment & Recovery
95
47
96
Pres. Comm. #47:
HHS, the Substance Abuse and Mental Health Services Administration (SAMHSA), and the Administration on Children, Youth and Families (ACYF) should disseminate best practices for states regarding interventions and strategies to keep families together, when it can be done safely (e.g., using a relative for kinship care). These practices should include utilizing comprehensive family centered approaches and should ensure families have access to drug screening, substance use treatment, and parental support. Further, federal agencies should research promising models for pregnant and postpartum women with substance use disorders (SUDs) and their newborns, including screenings, treatment interventions, supportive housing, non-pharmacologic interventions for children born with neonatal abstinence syndrome, medication-assisted treatment (MAT) and other recovery supports.
Green - Moving ForwardTreatment & Recovery
97
48
98
Pres. Comm. #48:
ONDCP, the Substance Abuse and Mental health Services Administration (SAMHSA), and the Department of Education (DOE) identify successful college recovery programs, including “sober housing” on college campuses, and provide support and technical assistance to increase the number and capacity of high-quality programs to help students in recovery.
Yellow - Some Momentum, Needs More FundingTreatment & Recovery
99
49
100
Pres. Comm. #49:
The ONDCP, federal partners, including the Department of Labor, large employers, employee assistance programs, and recovery support organizations should develop best practices on substance use disorders and the workplace.
Green - CompletedPublic Awareness; Family Outreach & SupportYellow > Green