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Commission on Combating Drug Addiction and the Opioid Crisis

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Commission on Combating Drug Addiction and the Opioid Crisis THE PRESIDENT’S COMMISSION ON COMBATING DRUG ADDICTION AND THE OPIOID CRISIS Roster of Commissioners Governor Chris Christie, Chairman Governor Charlie Baker Governor Roy Cooper Congressman Patrick J. Kennedy Professor Bertha Madras, Ph.D. Florida Attorney General Pam Bondi Table of Contents Chairman’s Letter…………………………………………………………………………………5 Summary of Recommendations .................................................................................................... 12 The Drug Addiction and Opioid Crisis ......................................................................................... 19 Origins of the Current Crisis ..................................................................................................... 19 Magnitude and Demographics .................................................................................................. 23 Newly Emerging Threats .......................................................................................................... 26 Pathways to Opioid Use Disorder (Including Heroin) from Prescription Opioids ................... 27 Health, Financial, and Social Consequences ............................................................................. 29 Drug Overdose Deaths .............................................................................................................. 31 Substance Use Treatment Availability ...................................................................................... 32 Systems Approach to Solutions ................................................................................................ 35 Federal Funding and Programs ..................................................................................................... 37 Streamlining Federal Funding for Opioids and Consideration of State Administrators ........... 37 Funding Effective Opioid-Related Programs ............................................................................ 38 Opioid Addiction Prevention ........................................................................................................ 40 Evidence-based Prevention Programs ....................................................................................... 42 SBIRT as a School Prevention Strategy ................................................................................ 43 Mass Media Public Education Campaigns ................................................................................ 44 Media Campaign Focusing on Opioids ................................................................................. 46 Opioid Prescription Practices .................................................................................................... 48 Improving upon the CDC Guideline for Prescribing Opioids for Chronic Pain and Provider/Prescriber Education ............................................................................................... 48 Enhancing Prescription Drug Monitoring Programs (PDMP) .............................................. 53 Prescription Take-Back Programs and Drug Disposal .......................................................... 55 Pain Level as an HHS Evaluation Criteria ................................................................................ 56 Reimbursement for Non-Opioid Pain Treatments .................................................................... 57 Reducing and Addressing the Availability of Illicit Opioids .................................................... 58 Improving Data Collection and Analytics ............................................................................. 58 Disrupting the Illicit Fentanyl Supply ................................................................................... 61 Interdiction and Detection Challenges .................................................................................. 63 Protecting First Responders from Harmful Effects Resulting from Exposure to Fentanyl and other Synthetic Opioids ......................................................................................................... 65 Opioid Addiction Treatment, Overdose Reversal, and Recovery................................................. 67 Drug Addiction Treatment Services .......................................................................................... 67 Increase Screenings and Referrals to Treatment through CMS Quality Measures ............... 67 Evidence-based Improvements to Treatment ........................................................................ 68 Insurance and Reimbursement Barriers to Accessing MAT ................................................. 69 Enforcing the Mental Health Parity and Addiction Equity Act (MHPAEA) ........................ 71 MAT in the Criminal Justice System .................................................................................... 72 Drug Courts and Diversion Programs ................................................................................... 73 Addiction Services Workforce and Training Needs .............................................................. 74 Response to Overdose ............................................................................................................... 77 Expanded Access and Administration of Naloxone .............................................................. 77 Overdose to Treatment and Recovery ................................................................................... 79 Recovery Support Services ....................................................................................................... 80 Impact on Families and Children........................................................................................... 80 Supporting Collegiate Recovery and Changing the Culture on College Campuses.............. 81 Employment Opportunities for Americans in Recovery ....................................................... 83 Support Recovery Housing .................................................................................................... 84 Research & Development ............................................................................................................. 86 New Pain, Overdose, and MAT Medications ........................................................................... 86 Medical Technology Devices .................................................................................................... 88 FDA Post-Market Research and Surveillance Programs .......................................................... 89 Conclusion .................................................................................................................................... 90 Current Federal Programs and Funding Landscape ...................................................................... 93 Overview ................................................................................................................................... 93 FY 2018 Funding Specific to America’s Opioid Crisis ............................................................ 93 The Comprehensive Addiction and Recovery Act (CARA) ................................................. 96 21st Century Cures Act .......................................................................................................... 96 FY 2018 Consolidated Federal Drug Control Budget ............................................................... 97 Prevention .............................................................................................................................. 97 Treatment and Recovery ........................................................................................................ 98 Domestic Law Enforcement ................................................................................................ 101 Interdiction........................................................................................................................... 102 International Efforts ............................................................................................................. 103 3 Charter, President’s Commission on Combating Drug Addiction and the Opioid Crisis .......... 107 Appendices .................................................................................................................................. 110 Appendix 1. Acronyms .......................................................................................................... 110 Appendix 2. History of Opiate Use and Abuse ...................................................................... 113 Appendix 3. Interim Report, President’s Commission on Combatting Drug Addiction and the Opioid Crisis ........................................................................................................................... 115 Appendix 4. Fentanyl Safety Recommendations for First Responders ................................. 125 References ................................................................................................................................... 126 4 ON COMBATING DRUG ADDICTION AND THE OPIOID CRISIS Governor Chris Christie Chairman Governor Charlie Baker Governor Roy Cooper Congressman Patrick J. Kennedy Florida Attorney General Pam Bondi Professor Bertha Madras, Ph.D. November 1, 2017 The Honorable Donald J. Trump President of the United States The White House 1600 Pennsylvania Avenue NW Washington, DC 20500 Dear President Trump, On behalf of the President’s Commission on Combating Drug Addiction and the Opioid Crisis, we thank
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