Last week, Senator Claire McCaskill’s (D-Mo) office released a report finding that over the last six years, enough opioids were shipped into the state of Missouri to give every resident 260 pills. While that is a snapshot of just one state, combine that news with the latest report from the Centers for Disease Control and Prevention (CDC) that the number of overdose deaths involving fentanyl and similar drugs nearly doubled between the last half of 2016 and the first half of 2017, and it becomes clear that the opioid crisis is still destroying the lives of individuals, families, and communities in epic proportions.
These reports follow a new CDC alert to public health and health care professionals about the increased availability of illicit synthetic opioids, the second update to the health advisory since October 2015. As the crisis continues to transform, health care providers, government agencies and Congress are also changing their tactics to fight this epidemic.
Over the past few weeks of extensive negotiations, the House of Representatives wrapped up multiple proposed opioid crisis bills into one large package, the SUPPORT for Patients and Communities Act (H.R. 6). This iteration of the bill would grant Nurse Practitioners and Physician Assistants permanent authority to prescribe Medication-Assisted Treatment (MAT) while the other three Advanced Practice Registered Nurse (APRN) professions (Certified Nurse-Midwives, Clinical Nurse Specialists, and Certified Registered Nurse Anesthetists) would have authorization for five years. The SUPPORT for Patients and Communities Act would also require a study of the efficacy of providing MAT by all providers, including physicians. H.R. 6 will now move to the Senate where there has been concern over the CBO estimated cost of $395 million over a 10-year period. Given the important role that treatment has in solving this epidemic, ANA does not believe this cost should impede the passing of this bill and increase access to life saving treatment to those suffering from substance use disorders.
Medication-Assisted Treatment has been shown to be the most effective form of treatment for opioid use disorders. The National Institute on Drug Abuse states that combined with behavioral therapy, effective MAT programs for opioid addiction decrease overdose deaths resulting in cost savings, reduce transmissions of HIV and hepatitis C related to IV drug use, and mitigate associated criminal activity. Along with APRNs providing MAT services, all nurses with their roles as direct care givers, care coordinators, educators, and patient advocates play a pivotal role in solving this crisis by helping patients and their families understand the risks and benefits of pain treatment options.
ANA will continue to work with Congress, federal agencies, and our partners in the Nursing Community to fight to expand the nurse’s role in solving the opioid crisis. We urge everyone to now call their Senators in support of Senate bill S.2317 (Addiction Treatment Access Improvement Act of 2018) and ensure that they include it in any opioid package that is passed.
Congress, government agencies, foundations, communities, and health care providers have been developing and implementing policies to turn the tide on the opioid epidemic for years. Nurses are on the frontline and in the trenches treating chronic pain, substance misuse, and mental health issues. Many health related policies and regulations are still ineffective in fixing the opioid epidemic, but we do know that using a criminal justice route to solve a public health problem will not succeed in its intent. But just this week, President Trump called for the death penalty, also known as capital punishment, for “certain drug dealers” in order to curb the opioid epidemic.
The American Nurses Association (ANA) opposes both capital punishment and nurse participation in capital punishment. Capital punishment and penalizing those convicted of certain classes of crimes by killing them violates the most basic human right, the right to life and liberty. The ethical standards of the profession obligates nurses to protect human rights and practice with respect for the inherent dignity, worth, and unique attributes of every. Instead ANA advocates for increasing access to Complementary Alternative Medicine (CAM) and Medication-Assisted Treatment (MAT), access to mental health services, and patient centered education.
The Trump administrations plan also includes a federally backed ad campaign to prevent non-prescribed opioid use. Education needs to extend past prevention measure to include safe use, storage, and disposal. Proper disposal of unused pills ensures that fewer opioids reach unintended persons and markets, and in turn, less misuse of narcotics.
Health care providers, public health officials, and law enforcement need to work together to implement proven policies that help all individuals and communities. Instead of taking a criminal justice path, such as the failed drug policies of the “just say no” campaign, which history has shown to perpetuate public health issues, officials need to take an interdisciplinary approach to address the underlying health, economic, social, and educational causes of drug use in both urban and rural communities. ANA is actively advocating for nurses through advising federal agencies, supporting federal legislation, and connecting members with their representatives to ensure the voices of nurses are heard.
The good news is that the budget unveiled Monday by the Trump administration is dead on arrival. The two-year agreement reached by Congress last week makes this budget even less relevant than most presidential budgets, and more importantly the congressional spending deal funds a number of crucial health programs that were in danger of losing funds. The bad news is that the President’s budget seeks to normalize policy proposals that would either cripple or eliminate altogether a number of crucial federal programs that provide critical aid for nurses and their patients.
Nursing Workforce Development Programs covered under Title VIII of the Public Health Service Act would be particularly hard hit, with cuts of almost 65% at a time when nurses nationwide desperately need this funding to continue providing quality care. The budget slashes $145 billion overall, eliminating all but one program under Title VIII (the NURSE Corps Loan Repayment and Scholarship Program, which would be funded at $83 million). As a result of this drastic and misguided approach, the Nursing Community Coalition (of which ANA is a member) announced their strong opposition earlier today.
Even when the President’s budget takes one step forward by allocating new funds, it simultaneously takes two steps back, as with funding to combat the opioid crisis. While the budget proposal would allocate $13 billion, experts estimate that at least $32 billion is needed to address this lethal epidemic. This new funding would also come at the expense of the Centers for Disease Control and Prevention (CDC), which would lose $1 billion and suffer particularly deep cuts to programs aimed at reducing chronic disease, bolstering public health preparedness, and overseeing occupational safety and health.
Perhaps most alarmingly, the budget embraces the approach of the already-rejected Graham-Cassidy legislation to repeal and replace the Affordable Care Act. This approach would implement massive cuts to Medicaid and eliminate its state-based expansion (which 33 states to date have chosen to embrace). It would also end the subsidies that help a vast majority of Americans who obtained health coverage under the ACA-implemented marketplace pay for their premiums.
Rather than promoting a misguided and out-of-touch budget, ANA urges the administration to instead focus on more pressing priorities, including helping Congress reach an agreement on those affected by the Deferred Action for Childhood Arrivals (DACA) program, as well as efforts to stabilize the health insurance marketplace following the repeal of the individual mandate late last year. Too many of the ideas included in this budget have been rejected by bipartisan congressional majorities. Like those ideas, this budget should similarly be put aside.