Issue Category: Substance Misuse and Mental Health

Collaborative Applauds HHS Move to Expand Efforts to Confront Opioid Abuse Epidemic

WASHINGTON, D.C. (March 27, 2015) – The Collaborative for Effective Prescription Opioid Policies (CEPOP) provided a ringing endorsement today for new actions to confront the opioid abuse epidemic announced March 26 by Health and Human Services Secretary Sylvia M. Burwell. The Administration’s initiative includes new funding to support health professional decision-making, the use of naloxone (a medication used to counter the effects of opioid overdose), and the expansion of medication-assisted treatment.

“Far too many families have been devastated by this epidemic,” observed CEPOP co-founder, Hon. Mary Bono. “These strategies are part of a comprehensive and coordinated effort to prevent opioid addiction and save lives. I’m encouraged by these positive steps.”

Community Anti-Drug Coalitions of America Chairman and CEO and CEPOP co-founder General Arthur Dean also commented that “the organizations participating in our Collaborative are dedicated to developing and advocating for solutions like these. I am confident that CEPOP will be mobilizing support for initiatives like this both in the federal budget process and on the ground in communities that are so deeply affected by this crisis.”

Jeffrey Levi, PhD, Executive Director of Trust for America’s Health and CEPOP co-founder, said “by promoting evidence-based strategies, these actions will help coordinate and align public health’s and traditional healthcare’s efforts to reduce opioid dependence and address the overdose crisis. CEPOP will continue to build a diverse and engaged group of organizations that advocate for a wide range of policy solutions to the opioid epidemic at the local, state and national level.”

About CEPOP

The Collaborative for Effective Prescription Opioid Policies (CEPOP) brings together a broad array of stakeholders interested in the appropriate use of opioid medications. Specifically, CEPOP supports a comprehensive and balanced public policy agenda that reduces abuse and promotes treatment options, both for those living with pain and confronting addiction. CEPOP’s advocacy is focused on driving actions in the public sector that develop and deploy evidence-based solutions to these challenges.

Trust for America’s Health’s Statement on the Public Health Aspects of the President’s Proposed Budget

February 3, 2015

Washington, DC, February 3, 2015 – The following is a statement from Jeffrey Levi, PhD, executive director of the Trust for America’s Health (TFAH) and chair of the Advisory Group on Prevention, Health Promotion, and Integrative and Public Health.

“If adopted, the President’s budget would take a major step toward building a culture of health in the United States, as it invests in programs and policies that enable Americans to be healthier – and to be better protected from infectious diseases, foodborne illnesses and other threats.

TFAH strongly supports the President’s proposal to end sequestration. Sequestration has resulted in sharp and indiscriminate cuts to public health programs – and ending it shows a commitment to the need for a strong, effective public health system in this country.

We are pleased to see increased support for programs that can improve health in people’s daily lives – where they live, learn, work and play. Mounting evidences shows programs like the Earned Income Tax Credit, the Child Care Tax Credit, early childhood education, family home visiting and the Children’s Health Insurance Program contribute to the long-term health of children and their families and are essential building blocks to a lifetime of wellbeing.

The proposal also recognizes the need for increased resources to fight one of the country’s fastest growing, most troubling and most preventable public health epidemics – devoting more than $100 million in new investments to combat prescription drug misuse and related heroin abuse.

In addition, the budget demonstrates how important ongoing investments into a standardized set of core “foundational capabilities” for all health departments are. All Americans should be assured that their state and local health departments have the same ability to help them be healthy. To this important end, the President’s budget identifies $8 million to start down the path of this kind of assurance.

However, while this is important, it is more than offset by the zeroing out of the $160 million Preventive Services Block Grant, a mechanism that is currently used by health departments to maintain capabilities and services. We recommend restoration of the block grant funding, along with clear direction that the funding be used for foundational public health capabilities and services.

Another low-point of the budget is the proposal to significantly cut chronic disease prevention programs – including some of the most important programs that support preventing obesity, tobacco cessation and related health problems. Given the national priority to reduce healthcare costs, this is particularly ironic since we know chronic diseases are one of the biggest drivers of these costs.

Some key public health highlights in the budget include:

  • A $36 million increase to the Strategic National Stockpile, which provides medicine and medical supplies to protect the American people during a public health emergency;
  • A $264 million investment to help the Centers for Disease and Prevention (CDC) combat antibiotic resistance;
  • A $107 million increase for the Biomedical Advance Research and Development Authority (BARDA) to spark the research and development of new antibiotics, vaccines, medical treatments and medical devices;
  • The creation of a single, independent food agency to provide leadership and prevent and respond to outbreaks of foodborne illness and an increase of $109.5 million to the Food and Drug Administration to implement the Food Safety Modernization Act (though much of this increase is in the form of unauthorized user fees which Congress should enact regardless of a policy decision on user fees). The creation of a single food safety agency has been a long-standing priority for TFAH and we hope it is the start of a broader coordination of public health programs across the federal government;
  • A $31.5 million increase in programs to combat viral hepatitis, almost doubling the nation’s resources;
  • A $10 million increase for the CDC climate and health program to fund 30 additional state and local grantees, though this is offset by an $11 million cut to the National Environmental Public Health Tracking program; and
  • A $128.1 million increase in the Vaccines for Children Program, though this is offset to some degree by a $50 million cut in the discretionary immunizations program.

Some key public health low-lights include:

  • Zeroing out the $160 million Preventive Services Block Grant – which is a key mechanism state and local public health agencies use to maintain capabilities and services;
  • A $20 million cut to the Partnerships for Improving Community Health (PICH), which works to address common risk factors for chronic disease;
  • A $7.5 million cut from the Division of Nutrition, Physical Activity and Obesity for programs focused on reducing obesity in high obesity rate counties; and
  • Elimination of the Racial and Ethnic Approaches to Community Health (REACH), which helps address key chronic disease conditions in the hardest hit populations.

TFAH looks forward to working with the Administration and Congress to ensure strong and sustained funding for public health – to foster a nationwide culture of health and improve the health and wealth of the nation.”

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Trust for America’s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority. 

Prescription Drug Abuse: Strategies to Stop the Epidemic

«state» has the «rank_2010» Drug Overdose Mortality Rate in the United States

«state» Scored «total_score» out of 10 on New Policy Report Card of Promising Strategies to Help Curb Prescription Drug Abuse

Washington, D.C. October 7, 2013 – «state» has the «lrank_2010» drug overdose mortality rate in the United States, with «rate_2010» per 100,000 people suffering drug overdose fatalities, according to a new report, Prescription Drug Abuse: Strategies to Stop the Epidemic.

The number of drug overdose deaths – a majority of which are from prescription drugs – «od_death_change_desc» have doubled in 29 states since 1999, quadrupled in four of these states and tripled in 10 more.

The report also finds that «state» received «l_total_score» out of 10 possible indicators of promising strategies to help curb prescription drug abuse. Nationally, 28 states and Washington, D.C. scored six or less, with New Mexico and Vermont scoring the highest, with a 10, and South Dakota scoring the lowest with two out of 10.

According to the report by the Trust for America’s Health (TFAH), prescription drug abuse has quickly become a top public health concern, as prescription drug related deaths now outnumber those from heroin and cocaine combined, and drug overdose deaths exceed motor vehicle-related deaths in 29 states«do_gt_mv_2010» and Washington, D.C. Misuse and abuse of prescription painkillers alone costs the country an estimated $53.4 billion a year in lost productivity, medical costs and criminal justice costs. The report also notes that, currently, only one in 10 Americans with a substance abuse disorder receives treatment.

“Prescription drugs can be a miracle for many, but misuse can have dire consequences. The rapid rise of abuse requires nothing short of a full-scale response – starting with prevention and education all the way through to expanding and modernizing treatment,” said Jeffrey Levi, PhD, executive director of TFAH. “There are many promising signs that we can turn this around – but it requires urgent action.”

In the Prescription Drug Abuse report, TFAH – in consultation with a number of public health, clinical, injury prevention, law enforcement and community organization experts – reviewed a range of national recommendations and examined a set of 10 indicators of strategies being used in states to help curb the epidemic. There are indications that some of these efforts and strategies may be having a positive impact – the number of Americans abusing prescription drugs decreased from 7 million in 2010 to 6.1 in 2011, according to the National Survey on Drug Use and Health.

Some key «state» findings from the report include:

No. Indicator Number of States Receiving Points
A “Y” means the state received a point for that indicator
1 Existence of Prescription Drug Monitoring Program (PDMP): Has an active program

«key_1»

49
2 PDMP: Requires mandatory utilization by prescribers

«key_2»

16
3 Doctor Shopping Laws: Has a law specifying that patients are prohibited from withholding information about prior prescriptions from their healthcare provider

«key_3»

50 and Washington, D.C.
4 Support for Substance Abuse Treatment Services: Participating in Medicaid Expansion, which helps expand coverage of substance abuse services and treatment

«key_4»

24 and Washington, D.C.
5 Prescriber Education Required or Recommended

«key_5»

22
6 Good Samaritan Laws: Has a law to provide a degree of immunity or mitigation of sentencing for individuals seeking to help themselves or others experiencing an overdose

«key_6»

17 and Washington, D.C.
7 Rescue Drug Laws: Has a law to expand access to, and use of naloxone, a prescription drug that can help counteract an overdose, by laypeople

«key_7»

17 and Washington, D.C.
8 Physical Exam Requirement: Has a law requiring healthcare providers to physically examine patients or have a bona fide patient-physician relationship before prescribing a controlled substance

«key_8»

44 and Washington, D.C.
9 ID Requirement: Has a law requiring or permitting a pharmacist to require an ID prior to dispensing a controlled substance

«key_9»

32
10 Lock-In Programs: Has a pharmacy lock-in program under the state’s Medicaid plan where individuals suspected of misusing controlled substances must use a single prescriber and pharmacy

«key_10»

46 and Washington, D.C.
Total «total_score»

“Fifty Americans die a day from prescription drug overdoses, and more than 6 million suffer from prescription drug abuse disorders. This is a very real epidemic – and warrants a strong public health response,” said Andrea Gielen, ScD, Director of the Johns Hopkins Center for Injury Research and Policy. “We must use the best lessons we know from other public health and injury prevention success stories to work in partnership with clinical care, law enforcement, the business community, community-based organizations, and other partners to work together to curb this crisis.”

Key recommendations from the report include:

  • Educate the public to understand the risks of prescription drug use to avoid misuse in the first place;
  • Ensure responsible prescribing practices, including increasing education of healthcare providers and prescribers to better understand how medications can be misused and to identify patients in need of treatment;
  • Increase understanding about safe storage of medication and proper disposal of unused medications, such as through “take back” programs;
  • Make sure patients do receive the pain and other medications they need, and that patients have access to safe and effective drugs;
  • Improve, modernize and fully-fund Prescription Drug Monitoring Programs, so they are real-time, interstate and incorporated into Electronic Health Records, to quickly identify patients in need of treatment and connect them with appropriate care and identify doctor shoppers and problem prescribers;
  • Make rescue medications more widely available by increasing access for at-risk individuals to naloxone and provide immunity for individuals and others seeking help; and
  • Expand access to and availability of effective treatment options as a key component of any strategy to combat prescription drug abuse.

According to the Centers for Disease Control and Prevention (CDC), nationally, sales of prescription painkillers per capita have quadrupled since 1999 – and the number of fatal poisonings due to prescription painkillers has also quadrupled. Enough prescription painkillers were prescribed in 2010 to medicate every American adult continually for a month.

“The release of the prescription drug abuse report by the Trust for America’s Health represents a significant step forward in elevating public awareness of the state of prescription drug abuse in the US”, according to Ginny Ehrlich, CEO of Clinton Health Matters Initiative (CHMI). “We are proud that the Trust has completed this important research as part of its CHMI Commitment to Action and congratulate the Trust on continuing to advocate for innovation and action towards addressing this public epidemic.”

The report was supported by a grant from the Robert Wood Johnson Foundation.

Score Summary: A full list of all of the indicators and scores, listed below, is available along with the full report on TFAH’s web site at www.healthyamericans.org and RWJF’s web site at www.rwjf.org/RxReport. For the state-by-state scoring, states received one point for achieving an indicator or zero points if they did not achieve the indicator. Zero is the lowest possible overall score, 10 is the highest. Data for the indicators were drawn from a number of sources, including the National Alliance for Model State Drug Laws, NCIPC, Centers for Disease Control and Prevention, the Alliance of States with Prescription Drug Monitoring Programs, the National Conference of State Legislators, the Network for Public Health Law, the Kaiser Family Foundation and a review of current state legislation and regulations by TFAH. In August 2013, state health departments were provided with opportunity to review and revise their information.

10 out of 10: New Mexico and Vermont

9 out of 10: Kentucky, Massachusetts, New York and Washington

8 out of 10: California, Colorado, Connecticut, Delaware, Illinois, Minnesota, North Carolina, Oklahoma, Oregon, Rhode Island and West Virginia

7 out of 10: Florida, Nevada, New Jersey, Tennessee and Virginia

6 out of 10: Arkansas, District of Columbia, Georgia, Hawaii, Iowa, Louisiana, Maryland, Michigan, North Dakota, Ohio, Texas and Utah

5 out of 10: Alaska, Idaho, Indiana, Maine, Mississippi, Montana, New Hampshire and South Carolina

4 out of 10: Alabama, Arizona, Kansas, Pennsylvania, Wisconsin and Wyoming

3 out of 10: Missouri and Nebraska

2 out of 10: South Dakota

STATE-BY-STATE DRUG OVERDOSE MORTALITY RANKINGS

Note: Rates include total drug overdose mortality rates, the majority of which are from prescription drugs. 1 = Highest rate of drug overdose fatalities,51 = lowest rate of drug overdose fatalities. Rankings are based on data from CDC’s National Center for Health Statistics, WONDER Online Database, 2010.The numbers are based on the number of people per 100,000.

1. West Virginia**** (28.9); 2. New Mexico (23.8); 3. Kentucky**** (23.6); 4. Nevada (20.7); 5. Oklahoma*** (19.4); 6. Arizona (17.5); 7. Missouri*** (17); 8. (tie) Tennessee** and Utah (16.9); 10. Delaware** (16.6); 11. Florida** (16.4); 12. Ohio*** (16.1); 13. Rhode Island** (15.5); 14. Pennsylvania (15.3); 15. Wyoming*** (15); 16. South Carolina*** (14.6); 17. Indiana**** (14.4); 18. Michigan*** (13.9); 19. Louisiana*** (13.2); 20. Washington (13.1); 21. (tie) District of Columbia and Montana** and Oregon** (12.9); 24. Colorado (12.7); 25. Arkansas** (12.5); 26. (tie) Alabama*** and Idaho** and New Hampshire** (11.8); 29. Alaska (11.6); 30. (tie) Mississippi***and North Carolina** (11.4); 32. (tie) Maryland and Massachusetts (11); 34. (tie) Hawaii and Wisconsin** (10.9); 36. Georgia*** (10.7); 37. California (10.6); 38. Maine (10.4); 39. Connecticut (10.1); 40. Illinois (10); 41. New Jersey (9.8); 42. Vermont** (9.7); 43. (tie) Kansas** and Texas (9.6); 45. Iowa**** (8.6); 46. New York (7.8); 47. Minnesota** (7.3); 48. Virginia (6.8); 49. Nebraska** (6.7); 50. South Dakota (6.3); 51. North Dakota (3.4).

** Drug Overdose Mortality Rates doubled from 1999 to 2010

*** Drug Overdose Mortality Rates tripled from 1999 to 2010

**** Drug Overdose Mortality Rates quadrupled from 1999 to 2010

Trust for America’s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority. For more information, visit www.healthyamericans.org.

New Report Provides High-Impact Recommendations to Improve Prevention Policies in America

January 29, 2013

Washington, D.C., January 29, 2013 – Today, Trust for America’s Health (TFAH) released A Healthier America 2013: Strategies to Move from Sick Care to Health Care in Four Years – which provides high-impact recommendations to prioritize prevention and improve the health of Americans.

The Healthier America report outlines top policy approaches to respond to studies that show 1) more than half of Americans are living with one or more serious, chronic diseases, a majority of which could have been prevented, and 2) that today’s children could be on track to be the first in U.S. history to live shorter, less healthy lives than their parents.

“America’s health faces two possible futures,” said Gail Christopher, DN, President of the Board of TFAH and Vice President – Program Strategy of the W.K. Kellogg Foundation.  “We can continue on the current path, resigning millions of Americans to health problems that could have been avoided or we invest in giving all Americans the opportunity to be healthier while saving billions in health care costs.  We owe it to our children to take the smarter way.”

The Healthier America report stresses the importance of taking innovative approaches and building partnerships with a wide range of sectors in order to be effective.  Some recommendations include:

  • Advance the nation’s public health system by adopting a set of foundational capabilities, restructuring federal public health programs and ensuring sufficient, sustained funding to meet these defined foundational capabilities;
  • Ensure insurance providers reimburse for effective prevention approaches both inside and outside the doctor’s office;
  • Integrate community-based strategies into new health care models, such as by expanding Accountable Care Organizations into Accountable Care Communities;
  • Work with nonprofit hospitals to identify the most effective ways they can expand support for prevention through community benefit programs;
  • Maintain the Prevention and Public Health Fund and expand the Community Transformation Grant program so all Americans can benefit;
  • Implement all of the recommendations for each of the 17 federal agency partners in the National Prevention Strategy; and
  • Encourage all employers, including federal, state and local governments, to provide effective, evidence-based workplace wellness programs.

“Prevention delivers real value as a cost-effective way to keep Americans healthy and improve their quality of life,” said Jeffrey Levi, PhD, executive director of TFAH.  “Everyone wins when we prevent disease rather than treating people after they get sick.  Health care costs go down, our local neighborhoods are healthier and provide more economic opportunity, and people live longer, healthier, happier lives.”

A Healthier America also features more than 15 case studies from across the country that show the report’s recommendations in action, such as:

  • The first-of-its-kind Accountable Care Community (ACC) launched by the Austen BioInnovation Institute in Akron, Ohio, which brings together more than 70 partners to coordinate health care inside and outside the doctor’s office for patients with type 2 diabetes.  By improving care and making healthier choices easier in people’s daily lives, the ACC reduced the average cost per month of care for individuals with type 2 diabetes by more than 10 percent per month within 18 months of starting the program – an estimated savings of $3,185 per person per year;
  • The Community Asthma Initiative (CAI), implemented by Boston Children’s Hospital, has provided support to improve the health of children with moderate to severe asthma in at-risk Boston neighborhoods.  The CAI has led to a return of $1.46 to insurers/society for every $1 invested; an 80 percent reduction in percentage of patients with one or more asthma-related hospital admission; and a 60 percent reduction in the percentage of patients with asthma-related emergency department visits; and
  • The Healthy Environments Collaborate (HEC) in North Carolina is an innovative partnership across four state agencies – Health and Human Services, Transportation, Environment and Natural Resources and Commerce. The partnership focuses on creating win-win policies and programs that improve health while also meeting other priority goals, such as improved transportation, increased commerce and stable housing programs.

In addition, the report includes recommendations for a series of 10 key public health issues: reversing the obesity epidemic; preventing tobacco use and exposure; encouraging healthy aging; improving the health of low-income and minority communities; strengthening healthy women, healthy babies; reducing environmental health threats; enhancing injury prevention; preventing and controlling infectious diseases; prioritizing health emergencies and bioterrorism preparedness; and fixing food safety.

The report was supported by grants from the Robert Wood Johnson Foundation, the W.K. Kellogg Foundation and The Kresge Foundation and is available on TFAH’s website at www.healthyamericans.org.

 Trust for America’s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority. www.healthyamericans.org

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