​Among the 56 final recommendations issued by the President's Commission on Combating Drug Addiction and the Opioid Crisis on November 1, 2017, are block-grant federal funding for opioid- and substance-use-disorder-related activities, Medicaid waivers for all 50 states to eliminate certain barriers to treatment, better alignment of state and federal privacy laws related to addiction, and mandatory provider education. Among the recommendations specifically of interest to healthcare providers are for policies to be put in place that ensure patient consent before administering opioid therapy for chronic pain. Patients must understand the risks, benefits, and alternatives when it comes to opioids, the Commission said. The U.S. Department of Health and Human Services (HHS) should coordinate a national curriculum and standard of care for opioid providers, the Commission said. The Commission also recommended that pharmacists be trained on best practices for opioids and that they not be penalized for denying inappropriate prescriptions. The Commission further recommended enhancements and improved data sharing and access to Prescription Drug Monitoring Programs. The Centers for Medicare and Medicaid Services (CMS) should remove pain survey questions entirely from patient satisfaction surveys, so that providers will not feel incentivized to deliver opioids, the Commission said. The government and hospitals should form partnerships for substance-use recovery efforts, the Commission also said. This includes providing expanded access to recovery coaches and referrals to substance-use-disorder treatment centers. The Commission also recommended that telemedicine policies be revised to allow for easier access to substance-use-disorder treatment and that new guidance for the Emergency Medical Treatment and Labor Act be developed on how to treat and stabilize patients with substance-use disorder in emergency departments. The recommendations come a week after President Trump declared the opioid crisis a national public health emergency, directing executive agencies to use every appropriate authority to fight it. (See HRC Alerts, November 1, 2017: White House Officially Declares Opioid Use a Public Health Emergency; What Does it Mean?). In related news, the U.S. Government Accountability Office (GAO) on October 31, 2017, recommended that HHS increase access to medication-assisted treatment. Meanwhile, cities in West Virginia are suing the Joint Commission and other accreditation agencies over their roles in the opioid crisis, according to a November 2, 2017, article in the Charleston Gazette-Mail. The suit alleges that these agencies took part in a “misinformation campaign" that downplayed the risks of opioids, the article said. Hospitals had to prescribe opioids to meet pain-management standards that were “zealously" enforced by accreditation agencies, helping to fuel the epidemic, the article says.

HRC Recommends: Risk managers should ensure that their facility's medical staff is trained and knowledgeable about pain-medication prescribing guidelines and practices and appropriate referral for treatment for individuals with substance-use disorders. Risk managers should encourage the facility to share its experience and knowledge regarding the opioid crisis with state and local officials as they begin to create programs, policies, and laws intended to address this multifaceted public health problem.