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CEO Update | 09

Congress Sends Veterans Bill to President Trump The Senate passed sweeping legislation this week to overhaul medical care options for the nation’s veterans. In a 92-5 vote, senators approved the VA Mission Act, a package totaling more than $50 billion that is intended to give veterans more access to private physicians and hospitals. “The Senate passage of the VA MISSION Act is a major victory for our nation’s veterans who will benefit from more choice and fewer barriers to care,” Sen. Johnny Isakson (R-Ga.), chairman of the Senate Committee on Veterans’ Affairs, said in a news release after the bill passed. According to a summary, the bill consolidates seven Veterans Affairs (VA) community care programs into on streamlined program; removes barriers for VA healthcare professionals to practice telemedicine; strengthens the process for VA and partnering healthcare providers who prescribe opioids to veterans; and requires VA to implement an information technology system to better support, assess and monitor the program. Senators Bob Corker (R-Tenn.), Jeff Merkley (D-Ore.), Mike Rounds (R-S.D.), Bernie Sanders (I-Vt.) and Brian Schatz (D-Hawaii) voted against the legislation, which President Trump is expected to sign in the coming days.   Senate Judiciary Approves Five Opioid Bills The Senate Judiciary Committee on Thursday passed five pieces of legislation to address the nation’s opioid crisis. Among the bills is the Substance Abuse Prevention Act, which would raise public awareness about opioid and heroin addiction (which the existing Comprehensive Addiction and Recovery Act (CARA) authorizes); provide resources for families to stay together when a family member is fighting addiction; and require the Attorney General and HHS to complete a plan for educating and training healthcare providers in best practices for controlled substances. Another bill — the Opioid Quota Reform Act—would allow the Drug Enforcement Administration (DEA) to consider additional factors when setting annual quotas for opioid drug production in the United States. Currently, DEA can consider only past sales and estimated demand. This legislation would allow the agency to consider diversion, abuse, overdose deaths and public health impacts when setting quotas, a summary noted.   House Majority Leader Pens Op-ed on Opioid Crisis House Majority Leader Kevin McCarthy (R-Calif.) this week summarized Congress’ efforts to fight America’s opioid crisis in an op-edpublished in USA Today. McCarthy highlighted Republican efforts to address the crisis and noted that although Congress’ legislative agenda is important, “healing the wounds of drug abuse” will take more than government action. “It will take a commitment by every citizen to fulfill our duties to one another,” McCarthy wrote. “That means supporting people near us who are struggling with drug addiction—and supporting their families and loved ones as well.”   FDA Approves First Non-Opioid Medication to Treat Opioid Withdrawal Symptoms The Food and Drug Administration (FDA) has approved the first non-opioid medication to treat opioid withdrawal symptoms after an advisory panel recommended its approval earlier this year. Lucemyra—the generic name is lofexidine—has been shown to result in less severe withdrawal symptoms and also to facilitate completion of a withdrawal protocol in two placebo-controlled studies, according to a story in Addiction Professional. The drug suppresses the neurochemical surge that produces withdrawal symptoms that include muscle spasms, stomach cramps and heart pounding. It is expected to be available on the U.S. market in August.   GAO Reports Need for Improvement in SAMHSA’s State Protection and Advocacy Programs In a new report, the Government Accountability Office (GAO) found that the Substance Abuse and Mental Health Services Administration (SAMHSA) should improve its procedures to oversee its state Protection and Advocacy for Individuals with Mental Illness (PAIMI). Established by Congress in 1986, the PAIMI grant awards totaled about $36 million in 2016. SAMHSA administers the grants to support state programs that protect and advocate for the rights of individuals with significant mental illness by investigating reports of incidents of abuse and neglect in facilities such as hospitals and also in the community. “GAO recommends that SAMHSA take steps to ensure that changes to performance benchmarks are examined over time, and to ensure onsite reviews are completed—and findings are provided to state programs— in a timely manner,” the report noted.   Separate NIH Studies Examine Depression Risk and Opioid Therapy for Chronic Pain A study published in the May 2018 issue of Preventive Medicine shows that African Americans and Latinos are “significantly more likely to experience serious depression” than Whites, although chronic stress does not appear to explain the differences. The study from the National Institute on Minority Health and Health Disparities (part of the National Institutes of Health) also found that African Americans and Latinos were more likely to have higher levels of chronic stress and more unhealthy behaviors. Researchers examined data on 12,272 participants between the ages of 40 and 70 from 2005 until 2012. Separately, a study from scientists at NIH and McGill University in Montreal found that pain-induced changes in the rat brain’s opioid receptor system may help explain the limited effectiveness of opioid therapy in chronic pain—and may play a role in the depression that often goes with it. “It’s well known that there’s a link between chronic pain and depression,” said M. Catherine Bushnell, Ph.D., scientific director of the National Center for Complementary and Integrative Health’s (NCCIH) Division of Intramural Research and one of the study’s authors. “The results of this study indicate that pain-induced changes in the brain’s opioid system may play a role in this association,” she added. “Animals with the greatest decrease in opioid receptor availability showed the greatest increase in depression-like symptoms after experiencing chronic pain.   Save the Date: NABH to Host 2019 Annual Meeting from March 18-20 in Washington, D.C. Please mark your calendars for March 18-20, 2019 and plan to attend the 2019 NABH Annual Meeting at the Mandarin Oriental Washington, D.C.! Also, please take a moment to view a brief photo gallery from the 2018 NABH Annual Meeting. For questions or comments about CEO Update, please contact Jessica Zigmond.