On October 21, 2015, President Obama issued a Memorandum to Executive Departments and Agencies (agencies), directing them to address the epidemic of prescription drug abuse and heroin use via increased prescriber training for health professionals and improved access to medication-assisted treatment. Issued along with the Memorandum was a fact sheet detailing actions that various federal agencies, including the Indian Health Service and the Bureau of Indian Affairs and federal contractors, are to undertake. In addition, it details the actions that 40 state, local and private sector organizations will be undertaking in concert with federal efforts. The Memorandum and the fact sheet are attached.
The Memorandum notes that the number of overdose deaths in the United States involving prescription opioids quadrupled between 1999 and 2013, with more than 16,000 deaths in 2013 alone. Heroin overdose deaths are also on the rise, nearly doubling between 2011 and 2013. The Centers for Disease Control has identified prescription drug addiction as a major factor in people turning to heroin use.
Prescriber Training for Federal Health Professional Employees and Contractors. The Memorandum directs agencies, to the extent permitted by law, to provide training on the appropriate prescribing of opioid medicines to their employees who prescribe controlled substances as part of their federal responsibilities. In addition, all contractors who are health care professionals, spend 50 percent or more of their clinical time under contract with the federal government, and prescribe controlled substances under the terms and conditions of their contract with the federal government must obtain this training. There is a similar requirement for clinical residents and clinical trainees. Training is to take place within 18 months of the issuance of the Memorandum followed by a refresher course every three years.
Improving Access to Medication-Assisted Treatment and Modernizing Benefit Design. The Memorandum directs agencies, to extent available and permitted by law, that directly provide, contract to provide, reimburse for, or otherwise facilitate access to health benefits to identify barriers to accessing medication-assisted treatment for opioid abuse. Within 90 days of the issuance of Memorandum (January 19, 2016) each affected agency is to submit an action plan to the White House that addresses these barriers. The Secretary of Health and Human Services (HHS) is to make available clinical and other experts to help agencies with their reviews as necessary.
Training of BIA Police Officers. The fact sheet states that with regard to the Bureau of Indian Affairs and the Indian Health Service that they “will provide BIA police officers and investigators the overdose reversal drug naloxone and training on its use. In 2016, the BIA, through the United States Indian Police Academy, will provide training to all BIA and tribal police officer cadets in recognizing opioid use disorders and overdose symptoms.”
Congress. The issue of increased prescription drug abuse and heroin addiction has received considerable attention in Congress. The Senate Committee on Indian Affairs held a hearing July 29, 2015, entitled The True Costs of Alcohol and Drug Abuse in Indian Country. Witnesses addressed the issue of opioid abuse in Indian Country. There was a specific focus on babies born addicted to opioids, their subsequent withdrawal and need for specialized lengthy intensive care, usually in a facility outside of the tribe’s area. Chief Executive Melanie Benjamin of the Mille Lacs Band of Ojibwe Indians referred in her testimony to babies being born addicted to opioids as “the single greatest threat” to the future of her tribe.
On October 22, 2015, the Senate approved by unanimous consent, S 799, the Protecting our Infants Act of 2015. The bill would require HHS to review and develop a strategy for addressing gaps in research and treatment related to prenatal opioid use, and to develop recommendations for prevention and treatment. It would direct HHS to solicit input from tribes, among others. A very similar bill, HR 1462, passed the House by voice vote, so prospects for enactment are reasonably good.
Please let us know if we may provide additional information regarding the President’s Memorandum on addressing prescription drug abuse and heroin use or other matters in this General Memorandum.