Letter to Sylvia Mathews Burwell, Secretary of U.S. Department of Health and Human Services - More Needs to be Done to Address Heroin Epidemic

Letter

Dear Secretary Burwell:

We commend the Department of Health and Human Services (HHS) for its commitment to develop a multi-pronged national strategy aimed at preventing opioid abuse. Given our shared concern about the growing rate of overdose deaths associated with heroin and prescription painkillers, we urge HHS to ensure that overdose prevention, specifically through the use of naloxone and other similarly effective drugs, figures prominently in the department's strategy. We also ask that the department coordinate with the White House to ensure that opioid abuse prevention priorities continue to be reflected in the 2015 National Drug Control Strategy, as well as the Fiscal Year 2016 budget proposal. We look forward to a strong focus on overdose education, naloxone distribution, and access to substance abuse treatment services and other follow-up care.

Despite the life-saving capabilities of naloxone, its use in overdose prevention is not widespread. A comprehensive plan for reducing overdose deaths should include adequate financial assistance for state and local governments, as well as community organizations, to purchase and distribute naloxone to first responders, law enforcement officials, medical facilities, and trained and qualified members of at-risk individuals' communities. We know that expanding naloxone access to a broader population can reverse drug overdoses and save lives, particularly when accompanied by education and training in overdose prevention and naloxone use.

We also encourage HHS to expand surveillance and data collection around opioid abuse and best practices in the field. In addition to focusing on preventing prescription drug misuse, abuse, and diversion, the national strategy HHS is developing should also explicitly focus on gaining a better understanding of how local efforts -- and federal programs and policies -- can prevent these unnecessary opioid overdose deaths and it is our hope that the FY2016 budget will support these efforts.

The plan should also include innovative ways to integrate naloxone into the health care delivery system. For example, HHS could establish best practices for co-prescribing naloxone with opioids for high-risk populations and ensure Medicaid coverage for all forms of naloxone. Another component of the plan should address recent price increases for commonly used formulations of naloxone by seeking to secure stable and affordable supplies of the drug.

Moreover, HHS should implement measures that connect overdose survivors and others in need of treatment with broader systems of care. While demand for services has grown dramatically, provider shortages, coverage barriers, and affordability prevent many from getting treatment. Initial reforms could include removing government restrictions that prevent drug treatment centers with more than 16 beds from billing Medicaid for services provided to beneficiaries, issuing guidance to payers regarding policies for lengths of stay and treatment intensity at substance abuse treatment facilities, and addressing policies that limit healthcare professionals from treating patients in need of medication assisted therapies for addiction. While the Mental Health Parity and Addiction Equity Act ensures higher levels of coverage for these services, the law does not provide details on duration or intensity of treatment, resulting in variable and insufficient treatment policies across payers.

Too many Americans have been lost to opioid overdose. We look forward to your leadership in developing a strategy that provides resources to improve overdose education, naloxone distribution, and substance abuse treatment services. We appreciate your consideration of these proposals and look forward to your response.