ONDCP Releases Plan to Reduce Prescription Opioid Overdose

Last month the Office of National Drug Control Policy (ONDCP) released a plan culminating six months of
collaboration across many different federal agencies that requires every state to monitor and track prescription
opioids. The plan, announced April 19, would also require more education of prescribers and dispensers
of prescription opioids, free up restrictions on disposal of unneeded or expired drugs, and work to shut
down “pill mills.”

The plan, however, doesn’t come with any funding requests. “There’s no additional supplemental funding
that we’re asking for,” said Rafael Lemaitre, spokesman for the ONDCP. “This relies on existing funding
streams and requests from the President for different programs,” he said. Manufacturers of opioids will pay
for the education of prescribers and physicians, he noted. The prescription drug monitoring program (PDMP)
utilizes the Hal Rogers Prescription Drug Monitoring Program, funded by the Department of Justice, instead
of the Substance Abuse and Mental Health Administration’s NASPER (National All Schedules Prescription
Electronic Reporting) Act, which is languishing for lack of funds.

However, the administration supports NASPER’s reauthorization in Congress. NASPER is a formula grant
program that funds state PDMPs and encourages interoperability, so that patients don’t cross state lines to
doctor-shop and otherwise obtain addictive drugs that are being tracked in their own state. The NASPER
grant program started in fiscal year 2009 with $2 million in grants to the states. NASPER was authorized by
Congress in 2005 at $15 million but received only $4 million of the funds, and the program is now expired.
Proposed legislation (H.R. 5710) is pending that would reauthorize it for three years. (For a review of the
funding dispute between NASPER and Hal Rogers, see ADAW, Nov. 16, 2009.)

“We’re in the process of the 2013 budget guidance,” Lemaitre told ADAW, adding that the next drug budget
may include provisions for funding some of the prescription drug strategy.

The plan was announced by the ONDCP, the Department of Health and Human Services (HHS), the Food
and Drug Administration (FDA), and the Drug Enforcement Administration (DEA). The FDA’s part of the plan
includes the Risk Evaluation and Mitigation Strategy (REMS), but the full opioid REMS still needs to be developed.
Drugs for which REMs will be required include transdermal fentanyl, methadone, extended-release morphine,
OxyContin and generic extended-release oxycodone, and transdermal buprenorphine. Go to http://1.
usa.gov/km4y7Y for the list of drugs for which REMS will be required.

Training

Under the plan, four agencies — the ONDCP, FDA, DEA, and SAMHSA — would “work with Congress to
amend federal law to require practitioners (such as physicians, dentists, and others authorized to prescribe)
who request DEA registration to prescribe controlled substancesto be trained on responsible opioid prescribing
practices as a precondition of registration,” the strategy states. “This training would include assessing
and addressing signs of abuse and/or dependence.”

Drug manufacturers would have to develop educational materials to train physicians “on the appropriate use
of opioid pain relievers,” an initiative that is the responsibility of the ONDCP, FDA, and SAMHSA.
There are also no special provisions for medication-assisted treatment for addiction using opioids — methadone
and buprenorphine. “The administration is very supportive of medication assisted treatment of substance
use disorders,” said Lemaitre. “However, the prescription drug action plan does not address that
specifically.”

Treatment provisions

The strategy suggests that addiction treatment providers already know how to detect substance abuse risks
in patients, but that other treatment providers — in particular, those who prescribe opioids for pain — do
not. “Outside of specialty addiction treatment programs, most healthcare providers have received minimal
training in how to recognize substance abuse in their patients,” the strategy document, called “Epidemic:
Responding to America’s Prescription Drug Abuse Crisis,” states.

Yet nothing in the strategy suggests that addiction treatment providers would receive special status, much
less be involved in the training of physicians in special issues involving opioids, such as tolerance.In fact, the
strategy, an expansion of the drug strategy, does include as a goal the addition by 10 percent of funding for
treatment, but does not indicate where these resources would come from. It also says the states would have
to increase reimbursement for Screening, Brief Intervention, and Referral to Treatment (SBIRT). However,
there is no specific reference to treating people who are addicted to prescription opioids.

Plan’s goals for reducing prescription drug abuse overdoses

The goals for prescription drug abuse under the ONDCP plan include:
• A 15% reduction in non-medical use of prescription psychotherapeutic drugs among young people age
12 and above within 5 years.
• An approved and implemented REMS for certain long-acting and extended release opioids within 1 year.
• and safe disposal within 2 years.
• A model Pain Clinic Medication Law within 1 year.
• A national public education campaign on prescription drug abuse and safe disposal within 2 years.
• Legislation passed within 2 years that requires prescribers applying for DEA registration to complete
training on appropriate use of Schedule II and III opioids.
• An increase by 25 percent in the number of states reimbursing for SBIRT within 2 years.
• Legislation in all 50 states establishing PDMPs within 3 years.
• Expansion by 10 percent, within 3 years, the available funding for treatment “since only a small fraction
of drug users currently undergo treatment.”
• Within 5 years, a decrease by 15 percent in the number of unintentional overdose deaths related to
opioids.

 

This article contribute by Alcoholism & Drug Abuse Weekly, a Wiley Periodicals, Inc. publication. View this
newsletter online at www.alcoholismdrugabuseweekly.com