By Brian Skinner, Esq.
An increasing number of reports in the national, state and local media suggests an upsurge in opioid- and other drug-related mortality—particularly from illicitly manufactured fentanyl and fentanyl analogs. Although nationwide data is incomplete, the data that is available suggests drug overdose deaths are on track to reach an all-time high.
Prior to the arrival of the Covid-19 pandemic, the U.S. was suffering the deadliest drug overdose epidemic in its history, with a record 71,000 overdose deaths last year. According to preliminary death data from the Centers for Disease Control and Prevention (CDC), between April 2019 and April 2020 there were nearly 74,000 overdose deaths, up from the 68,000 reported for the comparable period one year earlier. West Virginia is expected to see an 8.7% increase in overdose deaths for the same period.
Much of this increase can be attributed to the pandemic, which has left people stressed and isolated, disrupted treatment and recovery programs, and contributed to an increasingly dangerous illicit drug supply.
While stay-at-home orders and other restrictions have helped stop the spread of Covid-19, they have also had an impact on addiction treatment and counseling. The response to the pandemic had limited in-person engagement, which has exacerbated feelings of isolation and depression.
In light of these frightening statistics, the American Medical Association (AMA) has provided specific policy recommendations to help states and others amid the Covid-19 outbreak. The recommendations are intended to help guide policymakers reduce the stress being experienced by patients with an opioid use disorder (OUD) and pain as well as support efforts to continue harm reduction efforts in communities across the United States.
The following are some of the recommendations the AMA is urging governors and state legislatures to adopt to ensure access to care for patients with an opioid use disorder:
- Adopting new U.S. Drug Enforcement Administration (DEA) guidance providing flexibility for physicians managing patients with opioid use disorder. This includes authorizing prescriptions for buprenorphine for the treatment of opioid use disorder to new and existing patients based on an evaluation via telephone.
- Designating medications to treat addiction (buprenorphine, methadone, naltrexone) and medications to reverse opioid-related overdose (naloxone) as “essential services” to reduce barriers to access during “shelter-in-place” orders. The U.S. Drug Enforcement Administration has already waived federal requirements for in-person visits before controlled substance prescribing; we encourage states to take similar action for their controlled substance regulations.
- Prohibiting cost-sharing and prior authorization for medications used to treat addiction, including buprenorphine, methadone and naltrexone; allow for a 90-day prescription for patients receiving buprenorphine; payers should suspend all day limits on residential and intensive out-patient therapy.
- Requesting a blanket exception to SAMHSA for Opioid Treatment Programs (OTP) to receive Take-Home doses of a patient’s medication for opioid use disorder.
- Removing restrictions on the Medicaid preferred drug lists to help avoid medication shortages. This includes ensuring coverage for methadone for patients receiving care in an OTP.
- Temporarily waiving strict requirements in correctional and justice settings for submitting drug tests, in-person counseling and “check-ins” and similar requirements; suspend consequences for failure to meet strict reporting, counseling and testing requirements, including removal from public housing, loss of public benefits, and return to jail or prison. Additional efforts must be made to ensure people receiving MAT in criminal justice settings receive help in transitioning to care after release.
Given the impact that the opioid drug epidemic has had on the state, West Virginia should quickly adopt these recommendations. It is more important than ever that the state take steps to address this crisis, especially now that the pandemic is entering its ninth month and cases are at record levels across the nation.
Brian is the former counsel to the West Virginia House of Delegates Judiciary Committee and counsel to the West Virginia Senate Minority Caucus. He was also general counsel to the West Virginia State Health Officer and Commissioner for the Bureau for Public Health. He has almost two-decades of experience as a strategic advisor and chief legal counsel to both executive and legislative branch public officials.