Critique of the Opiate Commission's Preliminary Report: Unpacking Barriers and Missed Opportunities in the Opioid Crisis Response

This episode of Counselor Toolbox provides a critical analysis of the Opiate Commission's preliminary report, highlighting both its strengths and significant shortcomings in addressing the ongoing opioid epidemic. The report acknowledges the dire scale of the crisis, with approximately 142 Americans dying daily, equivalent to a September 11th death toll every three weeks. Key recommendations include rapidly increasing treatment capacity by waiving the Institutes for Mental Diseases (IMD) exclusion in Medicaid, mandating prescriber education on safe opioid prescribing and addiction screening, promoting Medication Assisted Treatment (MAT), and enhancing access to naloxone.\n\nWhile these recommendations are lauded for their intent, the host meticulously dissects the practical challenges and potential pitfalls in their implementation. For instance, increasing Medicaid-funded residential treatment faces hurdles like extensive provider enrollment procedures, staff retraining for Medicaid billing, and significant electronic health record modifications. Prescriber education is crucial, given that fewer than 20% of prescribers have received training on safe opioid use or addiction screening. However, the report's focus on 'proper treatment of pain' is noted as a potential shift away from unrealistic expectations of being pain-free, which often leads to overuse of medications.\n\nSignificant gaps are identified in the report's approach to Medication Assisted Treatment, despite its proven efficacy in reducing overdose deaths and relapse. Only 10% of conventional drug treatment facilities offer MAT, and access remains severely limited for veterans and Medicare recipients. The host also critiques the enforcement recommendations, such as increased border protection and fentanyl detection, by drawing parallels to Prohibition, suggesting that simply eliminating substances won't solve the underlying demand. Furthermore, the report's failure to address the uninsured, individuals with felony convictions, or those with high deductibles and co-pays is a major oversight, as these populations face insurmountable financial barriers to treatment.\n\nFinally, the episode scrutinizes the recommendations for prevention programs and pain scaling. While prevention is vital, the report lacks concrete strategies for operationalizing these programs in schools, where academic testing often takes precedence over counseling. The concept of 'pain scaling' is praised for shifting the focus from complete pain elimination to realistic management. However, the call for evidence-based practices in treatment programs is tempered by the reality of high training costs for agencies. The host concludes by emphasizing the need for a more holistic, accessible, and financially viable approach that considers the full spectrum of barriers to treatment and recovery, particularly for the most vulnerable populations.

"approximately 142 Americans dying every day America is enduring a death toll equal to September 11th every three weeks"

"This exclusion prevents federal Medicaid funds from reimbursing services provided in an inpatient facility treating mental diseases including substance use disorders that have more than 16 beds"

"fewer than 20% of the over 1 million prescribers licensed to prescribe controlled substances have patient training on how to prescribe opioids safely"

"four out of five new heroin users begin with non-medical use of prescription opioids"

"Medication assisted treatment has proven to reduce overdose deaths retain people in treatment decrease the use of heroin reduce relapse and prevent the spread of infectious diseases"

"only 10% of conventional drug treatment facilities provide medication assisted treatment for opioid use disorder"

"Medicare in most cases does not pay for medication assisted treatment"

"naloxone will save lives and give people a chance at treatment"

"Code of Federal Regulations 42 part 2 or you may know it as CFR 42 part 2 prohibits clinicians who work with somebody with addictions from divulging the information that they have an addiction"

"the uninsured single men without dependent children may not be able to qualify for Medicaid may not be able to afford insurance and persons with felony convictions in many states are not able to get medicaid"

"most Americans can't scrape together two thousand dollars for an emergency medication is therapy for example costs on average thirty five hundred to six thousand dollars per year without counseling"

"pain scaling the examination of the need for satisfaction with pain level as a satisfaction criteria through which a healthcare provider is evaluated is an important recommendation"