Center for Lawful Access and Abuse Deterrence 9/8/2014

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1 ASPMN 24 th National Conference San Diego, CA September 17 20, 2014 Addressing an Evolving Epidemic Through Substance Use Intervention and Treatment Policies Michael C. Barnes Executive Director Conflict of Interest Disclosure The Center for Lawful Access and Abuse Deterrence (CLAAD) receives funding from businesses in the health care industry that share CLAAD s mission to reduce prescription drug fraud, diversion, misuse, and abuse while advancing consumer access to high quality health care. CLAAD s funders include pharmaceutical companies, treatment centers, and laboratories, and are disclosed on its website, CLAAD is managed by DCBA Law & Policy. DCBA also provides legal and policy counsel to professionals and businesses whose activities align with CLAAD s mission. To avoid conflicts of interest, DCBA adheres to the District of Columbia Rules of Professional Conduct Any views or opinions in this presentation are solely those of the author/presenter and do not necessarily represent the views or opinions of the American Society for Pain Management Nursing. Preview Introduction Responses to Opioid Abuse Trends in Substance Use Shifts in Supply Diminished Perceptions of Risk Affronts to Federal Authority More Therapeutic, Less Punitive Approach Crucial Role of Nurses Conclusion 1

2 Introduction Mission Lawful access: consumer access to high quality health care Moderation Abuse deterrence: preventing fraud, diversion, and abuse Information and analysis Policy leadership (governmental, corporate, professional) Coalition building (resource sharing and harmonization of efforts) Rx Abuse: Are We Making Progress? Federal Responses to Opioid Abuse Prosecutions and DEA enforcement (distributors, pharmacies) LA/ER opioid REMS (voluntary education) Secure and Responsible Drug Disposal Act Grant support (PMPs, research) Abuse deterrent opioids (federal legislation) New opioid labels ( severe enough ) Hydrocodone rescheduling recommendation 2

3 State Responses to Opioid Abuse Successful prosecutions Second degree murder (knowing indifference to consequence) Involuntary manslaughter (harmful activity w/o due caution) Mandatory PMP data checks Mandatory prescriber education all controlled substances Good Samaritan, naloxone laws first responders Pain clinic registration and regulation Safe prescribing and abuse prevention standards Corporate Responses to Opioid Abuse Pharmaceutical research and development Pain Addiction Testing for substance use Pharmacogenetic risk More definitive urine testing w/ greater sensitivity, specificity, accuracy and reliability (not yet implemented in sports) Locking devices Insurer data analysis and alerts Rx Abuse: Yes, We Are Making Progress Overdose deaths from opioids fall 27% in WA (1/28/14) Prescription drug deaths falling across FL (10/14/13) National survey shows reduced levels of Rx abuse among young adults (9/4/13) KY sees decline in drug overdose deaths, including Rx overdose (8/8/13) Opioid medication abuse down in 10 states (KY, LA, MA, MS, NH, NY, OH, OK, RI, WV) (1/8/13) Abuse deterrent medications can reduce the risk of diversion, misuse, and abuse (July 2012) 3

4 Shifting Supply Heroin use and buprenorphine misuse Decreasing supply of Rx medications available for abuse w/o corresponding demand reductions Raiding before regulating leads to denials of Rx medications for people with pain and SUDs Distributors, pharmacies MAT prescribers FedEx Greater availability of marijuana New substances of abuse Diminished Perceptions of Risk Alcohol: present in the household; a rite of passage Opioids, stimulants, and benzodiazepines: prescribed by a doctor, available at a pharmacy Marijuana: medicine and recreation ( safer than sugar ) Synthetics: available at malls, convenience stores, and online Analogs and counterfeits: same drug, slightly modified formulation, package, or language; available online E cigarettes: clean delivery of nicotine, THC, and opioids 3D printing: ordered online and printed at home Affronts to Federal Authority Ballot measures and legislation Importation of non FDA approved drugs Specific medication bans City and county level interference The Best of Both Worlds: Applying Federal Commerce and State Police Powers To Reduce Prescription Drug Abuse. MD. J. HEALTH CARE L. & POL Y (2013). 4

5 More Therapeutic, Less Punitive Approach ACA & Equity Act expand access to treatment Educate consumers Challenge insurance denials Acceptance of medication assisted treatment Drug courts reduce costs and recidivism Expansion of interventions and referrals to treatment Health care, education, employment, and criminal justice systems Non punitive testing for substance use Proposals for sentencing reform and voting rights restoration Crucial Role of Nurses Lead the implementation of best practices Watchdog and whistleblower Professional associations like ASPMN wield influence Break stereotypes and stigma Improve macro level policies and practices Touch every community and family Tremendous prevention and intervention resource Geographically dispersed Passion and credibility on issues Unified Call for Balance Jailing moms and seizing newborns in response to NAS Attacks on therapeutic testing for substance use Action against MAT practitioners Denials of care, turning away from treatment Barriers to medication assisted therapy Profiteering of dirty docs and liquid gold labs Prescription monitoring program data breaches 5

6 Policy Resources (since May 29, 2014) Blowing the Whistle on Dirty Docs Overdose Prevention Act (warm hand off) legislative proposal Letter of support for H.R (regulate before raiding) Safer Opioid Prescribing and Abuse Prevention Standards for Pain Management Principles for Urine Drug Testing in Addiction Medicine Practitioners May Not Profiteer from Drug Testing ACLU s Lawsuit Exemplifies Confusion Regarding Therapeutic Testing for Substance Use Law Review Articles Applying Lessons from the Opioid Abuse Epidemic to Protect Consumers from Gray Market Biologics, NOTRE DAME J.L. ETHICS & PUB. POL Y (Forthcoming 2014). Active Verification and Vigilance: A Method To Avoid Civil and Criminal Liability When Prescribing Controlled Substances, DEPAUL J. HEALTH CARE L. (2013). The Best of Both Worlds: Applying Federal Commerce and State Police Powers To Reduce Prescription Drug Abuse. MD. J. HEALTH CARE L. & POL Y (2013). Conclusion Thanks to Dr. Marsha Stanton and Pamela Bennett LinkedIn.com/in/michaelcbarnes CLAAD.org Thank You Questions and Discussion 6