In “Opioid Crisis Legislative Update,” Jessica Siegel, NRHA, touches on the recent discussion draft of bipartisan Opioid Crisis Response Act of 2018 by Senator Lamar (R-TN) and Senator Patty Murray (D-WA).

“The opioid crisis is currently our most serious public health epidemic, and despite efforts in every state, it is getting worse.” Senator Alexander

In a bane to address the opioid epidemic and its devastating effects, the legislation follows a series of six hearings held by the Senate Health, Education, Labor, and Pensions (HELP) Committee since October 2017; intending to boost the capacity of the Department of Education, Labor and Health and Human Services (HHS). “The opioid crisis is currently our most serious public health epidemic, and despite efforts in every state, it is getting worse.” Senator Alexander explained, and he continued “Our response needs to be urgent, bipartisan and effective.”

Combatting the Opioid crisis: Improving the ability of the Medicare and Medicaid to provide care for parents” Is a second hearing scheduled by the House Energy andOpioid Crisis In Rural America Commerce Committee this spring as their work to compile an opioid legislation package.

Rural Americans have experienced the devastating effects of the opioid epidemic since the onset of the crisis. Although, only about 20% of American live int he Rural areas, a disproportionately high proportion of those communities are battling with heroin abuse and prescription opioids. Rural Americans, according to the Centers for Disease Control and Prevention, are more vulnerable to overdose and prescription painkiller abuse. A study shows, the rate of opioid-related overdose deaths in non-metro counties is about 45% higher than in metro counties.

Proportional Allocation of Funding

The House and Senate authorized $1 billion for the funding of the next two years of Opioid Epidemic Combat in the 21st-century cures legislation passed in 2016. Lately, based on mortality and size of each state, there has been an allocation of the funds to the states. Lawmakers responsible for the legislation proposed the utilization of “per-capita formula” during the distribution; to account for the demands of smaller states that are more affected by the crisis. West Virginia has the most number of overdose death rate in the country, but only received $5.8 million out of the $500 million allocated for this year. Second-ranked New Hampshire was given $3.1 million, and Kentucky, the third highest received only about $11 million. Texas and California, though larger states with more significant populations, had some of the lowest overdose death rates in the country proportionately. Nevertheless, Texas received $27.3 million and California received $44.7 million.

the current formula does not appropriately consider the strength and proportion of the hit. Instead, it favors the large states!

Opioid Crisis In Rural AmericaIn order to ensure, and at the same time, create an opportunity for the states that have taken the harder hit from the opioid endemics to recover, there should be a proportional distribution of funds. However, the current formula does not appropriately consider the strength and proportion of the hit. Instead, it favors the large states! However, it is delightful to recognize that the Opioid Crisis Response Act has somewhat corrected the flaw by focusing federal funds on states and tribes that are most impacted by the crisis. The bill would adequately update the finance plan approved by the 21st Century Cures Act to provide an accurate account of overdose deaths in each state.

Treatment Possibilities: Telemedicine and MAT

Medication Assisted Treatment (MAT) has been tagged to have achieved massive success by reducing drug use and the rate of accidental overdose. Less than 40% out of the 2.5 million people suffering from substance use disorder have access to MAT. Here are the statistics: Administering buprenorphine is the easiest training to complete, but out of the Opioid Crisis In Rural America2.2% of physicians in the U.S. who received a waiver to prescribe buprenorphine, 90.4% practice in non-urban counties. No physician has gotten a waiver in about 82.5% rural counties. This legislation plans to establish a permanent capacity whereby nurse practitioners and physician assistants would be able to prescribe MAT, and physicians would also have the capability to prescribe MAT to a more significant number of patients.

Opportunity for more care is made available by Telemedicine in underserved communities. Health Professional Shortage Areas (HPSAs) is inherent in 77% rural communities, more also, there are no psychologist, psychiatrist or social workers in most rural areas. Efforts are made by Opioid Crisis Response Act to improve the regulations under the Drug Enforcement Association to expand access to telemedicine. Community mental health and addiction treatment centers would be allowed by legislation to register with the DEA to treat patients using telemedicine. By doing so, qualified centers could work with the DEA to treat more patients in the rural areas.

Workforce and Provider Deficits

Moreover, to tackle the challenge of the workforce and provider deficit in rural areas, health providers engaging in the National Health Service Corps (NHSC) via Health Resources and Service Administration (HRSA), should be allowed by the legislation to provide services in school areas with the hardest hit and mental health professional shortages. This will create room for licensed substance use disorder (SUD) treatment counselors to receive loan repayment for practicing in underserved areas.

The bill also awards grants to accommodate the economic and workforce impact of the opioid crisis. The objective of those grants is to assist the state workforce boards to target workforce shortages in substance use and behavioral health treatment workforce. They would also improve treatment services and the streamlining of job training. The intention of these two provisions should be more explicitly focused on rural areas.

Medicaid and Medicare Coverage

An attempt is made to find a cure for the opioid epidemic; there is a demand to consider coverage of treatment under Medicare and Medicaid, particularly for the rural population. The Energy and Commerce Committee is putting into consideration more than two dozens of bills which would expand access to an opioid treatment program. Including telemedicine and other alternative SUD treatments.

There is a longing to see the Energy and Commerce Committee include the Caring Recovery for Infants and Babies (CRIB) Act in their consideration of Medicaid and Medicare treatment for opioids. NY NRHA supported the Legislation that institutes pediatric careers under Medicaid, in order to provide treatments for babies born to mother with Alcohol Use Disorder -who suffer from neonatal abstinence syndrome (NAS).

Insufficient and inadequate health care resources and economic opportunity in the rural areas, has made them vulnerable to substance abuse

Finding Resolutions for Rural America

The destructive and catastrophic toll of the opioid crisis cannot be overlooked or overemphasized, especially for the populations of the rural areas that are still battling to recover from the great recession. Insufficient and inadequate health care resources and economic opportunity in the rural areas, has made them vulnerable to substance abuse, which creates a platform for despair. As we work together and put in efforts to tackle the issue of opioid crisis in America, we cannot factor out the rural areas. There should be a joint effort to develop a holistic approach that is practical even in most remote areas.



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