Lawrence is the Chair for Obermayer’s Health Care Law Department and Election Law Practice Group. Lawrence’s Health Care Law legal experience includes the representation of Pennsylvania County governments in Behavioral Health Managed...Read More by Author
Antidotes for America’s Addiction Crisis
Opioid addiction and abuse has exploded into a national epidemic. Every three weeks, America faces a death toll equivalent to the September 11th attacks due to drug overdoses, 75 percent of which are from opioid use. With more Americans dying each year from drug overdoses than gun violence and car crashes combined, the issue has been catapulted to the forefront of national policy. According to the Centers for Disease Control and Prevention (CDC), one of the biggest sources of opioid addiction has been the extensive use of opioid painkillers in clinical treatment. A recent report from the CDC found that enough opioids were prescribed in 2015 “for every American to be medicated around the clock for 3 weeks.” Therefore, the government and public health policy makers have looked for ways of reducing the use of opioids in clinical care to diminish increases in addiction.
Recently, the US Department of Justice (DOJ) and the Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) have taken steps to combat the overuse of opioid prescriptions in federal healthcare programs. In July 2017, the DOJ instituted fraud charges against 115 doctors, nurses, and licensed professionals related to false billing from the unlawful prescription and distribution of opioids.
Similarly, the OIG issued a data brief detailing the use of opioids in the Medicare population. The report looked at prescription patterns and found high levels of opioid abuse risk through excessive dosages and evidence of “doctor shopping.” This also raises concerns regarding the risk of prescription diversion and resale outside of the Medicare population. OIG stated that it plans to use these data resources to partner with law enforcement and the Centers for Medicare and Medicaid Services to identify problematic prescribers in an effort to combat opioid abuse.
These actions signal to providers that HHS, OIG, and DOJ are intolerant of the over-prescription of opioids and intend to hold providers that engage in such misconduct accountable. Providers must be cautious in prescribing these substances and should closely follow the guidelines provided by federal agencies to avoid prosecution under the increased scrutiny of HHS and DOJ.
Additionally, federal and state efforts to aid those already addicted are an equally important component to addressing the crisis. A White House Commission assembled to examine the opioid crisis and ways in which the government can take action recently released a report that offered several policy recommendations for aiding Americans struggling with addiction. The recommendations included the expansion of Medicaid’s capacity for substance abuse treatment. While Medicaid covers substance abuse treatment, many facilities do not accept Medicaid, which severely restricts access to care. However, Pennsylvania has been a leader in working to counteract this phenomenon by funding forty-five “Centers of Excellence” (COE) throughout the state. The COE are tailored to treat opioid use disorders by coordinating a Medicaid recipient’s care through different types of providers, including behavioral health treatment under the HealthChoices Behavioral Health Program.
To read more about Pennsylvania’s response to the opioid crisis, please click here.