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CEO Update | 15

Number 15 July 13, 2018 Justice Department Announces Regulations to Address Opioid Crisis The Justice Department this week made final a rule it proposed in April to improve the Drug Enforcement Administration’s (DEA) ability to control diverting dangerous drugs during the nation’s opioid crisis. The rule establishes that DEA will consider the extent to which a drug is diverted for abuse when the agency sets its annual opioid production limits. This means that if DEA officials believe a particular opioid or a particular company’s opioids are being diverted for misuse, the agency can reduce the amount that can be produced in a given year. Click here for more information.  NIMH-Supported Study Examines EHR Model to Predict Suicide Attempts and Suicide Deaths The National Institute of Mental Health this week highlighted a study published earlier online in the American Journal of Psychiatry in which researchers at the Kaiser Permanente Washington Health Research Institute sought a better way to predict suicide attempts and suicide deaths in the 90 days after a mental health diagnosis.  The model used data from electronic health records (EHRs) from seven health systems, including the Henry Fords Health System in Detroit, the HealthPartners Institute in Minneapolis, and the Kaiser Permanente regions of California, Colorado, Hawaii, Oregon and Washington. “By leveraging existing electronic health record data and advancements in statistical modeling, it is possible to significantly improve the prediction of death by suicide and suicide attempts over conventional self-report methods,” said Michael Freed, Ph.D., chief of the Services Research and Clinical Epidemiology Branch in NIMH’s Division of Services and Intervention Research. “Valid and reliable suicide risk prediction models hold tremendous promise to reduce death by suicide, especially when integrated with evidence-supported approaches to suicide prevention.” New Research Highlights Increasing Medications to Treat Opioid Addictions A recent study in the Annals of Internal Medicine has heightened interest in using medications to treat opioid addictions. “Medication for opioid use disorder after nonfatal opioid overdose and association with mortality: A cohort study” (Annals of Internal Medicine, June 19, 2018) found that for the year after a nonfatal overdose:
  • Methadone reduced overdose deaths by 59 percent
  • Buprenorphine reduced overdose deaths by 38 percent
  • Fewer than one-third of all patients received a medication for opioid use disorder in the year following a nonfatal overdose
  • Naltrexone showed a one-month average retention rate, compared to five months for methadone and four months for buprenorphine.
Following the study, the July 5th issue of The New England Journal of Medicine published three articles about strategies that promote using medications in primary care settings to treat opioid use disorders. These include: “Primary care and the opioid crisis”: Authors Wakeman and Barnett dispel stigma and certain myths about buprenorphine prescribing that make primary care physicians reluctant to prescribe ‘bupe,” including perceptions that bupe treatment is more dangerous, substitutes one addiction for another, more onerous than other treatments, and that reducing the prescribing of opioids will put an end to the overdose epidemic. The authors also debunk as myth that detoxification treatment is effective. Defined as short-term, abstinence-based residential treatment, the article states that research demonstrates this model is ineffective and may increase opioid overdoses by reducing tolerance and increasing the risk of death. “Improving the quality of buprenorphine treatment”: Authors Saloner, Stoller, and Alexander suggest that primary care-based buprenorphine prescribing provides a unique opportunity for true integration of addiction and medical care, including coordination across care to detect the use of opioids and benzodiazepines.  The authors recommend collaboration between specialty and primary care to increase the number of bupe providers; increase the duration of bupe treatment; use quality outcome measures to evaluate population-wide outcomes across levels of care; and improve reimbursement methodologies and extend bundled payments and shared savings arrangements to specialty addiction providers. “Methadone in primary care—one small step for congress, one giant leap for addiction treatment”: Authors Samet, Botticelli, and Walley propose that it’s time for the U.S. to permit methadone to be administered in the primary care setting, as is done in Canada, Great Britain, and Australia. Permitting administration by buprenorphine prescribers would not only fill geographical gaps caused by zoning issues, but also allow all three opioid medications to be offered in one place.  Justification for this approach is found in a risk-benefit analysis in evaluating potential safety issues against 2017 research that shows a reduction in all-cause mortality for those treated with methadone or buprenorphine. HRSA Applications for SUD and Mental Health Services Funding Due Monday, July 16 Applications for federal money to support Health Services and Resources Administration (HRSA)-funded health centers by implementing and advancing evidence-based strategies to expand access to integrated substance use disorder and mental health services are due on Monday, July 16. According to HHS, there is about $350 million available for these awards, which will be announced in September. Click here to learn more and apply for funding. Webinar Presentation on IPFQR Program FY 2019 Requirements Now Available The Quality Reporting Center has posted slides from a webinar this week that summarizes the Fiscal Year (FY) 209 Inpatient Psychiatric Facility Quality Reporting (IPFQR) Program requirements and includes tips to submit data successful. Click here to view the presentation. SAMHSA to Award Opioid-Related Funding Awards The Substance Abuse and Mental Health Services Administration (SAMHSA) will award 59 grants to state governments for prevention, treatment and recovery efforts for opioid use disorder (OUD). Grantees of the program will use data to identify gaps in availability of treatment by geographic, demographic and service-level terms, and use evidence-based implementation strategies “to identify which system design models will most rapidly and adequately address the gaps in their systems of care.” The application deadline is August 13. Click here for more information. SAMHSA will also award 263 grants to supplement current activities for federally recognized American Indian/Alaska Native tribes or tribal organizations to increase access to culturally appropriate and evidence-based treatment of OUDs. The deadline is August. 20. SAMHSA will host three webinars on this topic in the coming weeks. Click here to learn more.   For questions or comments about CEO Update, please contact Jessica Zigmond.