Five To Know: The Opioid Workforce Act

Over the past decade, opioids and the devastation they have caused to patients has become a near-daily news item. From 1999 to 2008, there was a fourfold increase in overdose deaths,¹ and in 2017, there were more than 70,000 deaths from drug overdoses, including illicit drugs and prescription opioids, which was a twofold increase over the prior decade.²

In an effort to curtail the spike of deaths from opioids, in 2017 the Department of Health and Human Services (HHS) declared a public health emergency to address the national opioid crisis. HHS also released a five-point strategy to combat the crisis, which included:

• Improving access to prevention, treatment and recovery support services
• Targeting the availability and distribution of overdose-reversing drugs
• Strengthening public health data reporting and collection
• Supporting cutting-edge research on addiction and pain
• Advancing the practice of pain management³  

In 2019, the Centers for Disease Control and Prevention announced $900 million “in new funding for a three-year cooperative agreement with states, territories, and localities to advance the understanding of the opioid overdose epidemic and to scale-up prevention and response activities.”⁴ 

But fighting the opioid epidemic takes more than just money. It takes considerable resources from healthcare employees, whether in administrative positions as well as from those delivering care. According to a 2018 report from the Substance Abuse and Mental Health Services Administration, about 21 million people needed treatment for substance use disorder in 2018, but only 11 percent actually received treatment.⁵ A big reason for that? A shortage of physicians trained to treat addiction. To that end, the Opioid Workforce Act of 2019 aims to help relieve some of the burden on healthcare workers in combating this crisis. Here’s what you need to know about this proposed bill. 

1. What is the Opioid Workforce Act of 2019?

Introduced in June 2019, this bipartisan act aims to “support hospitals in hiring and training doctors in addiction medicine, addiction psychiatry and pain management.”⁶ Under the Act, there will be Medicare support for 1,000 new medical residency positions created at teaching hospitals across the country over the next five years.

2. Who is involved? 

Hospitals that have, or are establishing, accredited residency programs in addiction medicine, addiction psychiatry or pain medicine are eligible to hire for these positions to help address the gap in physicians trained in these services. The legislation allows for up to 25 positions to be created per hospital. More than 80 organizations, including the American Society for Clinical Pathology (ASCP), support the bill. It is being led in the House of Representatives by Brad Schneider (D-IL), Susan Brooks (R-IN), Elise Stefanik (R-NY), and Ann Kuster (D-NH), and in the Senate by Senators Maggie Hassan (D-NH) and Susan Collins (R-ME). 

3. How would this affect the laboratory?

While the legislation does not include money or Graduate Medical Education slots for pathology or laboratory medicine, one of the focal points of the legislation is strengthening public health data reporting and collection efforts. Laboratories will play a crucial role in this aspect, providing data that the Centers for Disease Control and Prevention can use to better understand and identify problems. As a recent position paper from the AACC notes, “Laboratory expertise can help clinicians monitor pain management and addiction treatment patients to prevent illicit opioid usage. Laboratories generate data that can support the timely assessment of drug trends and facilitate a faster response to overdose outbreaks.”⁷

What’s more, two surveillance initiatives—the Enhanced State Opioid Overdose Surveillance and the National Syndromic Surveillance Program—support the data collection and analysis process, the former of which recently received new funding that helped “directly support medical examiners and coroners, including for the comprehensive toxicology testing.”⁸  

With tracked data provided by the laboratory, information can be reported and shared with relevant stakeholders who could then “take precautions or mobilize a response.”⁷

That data and information is necessary to fight the opioid epidemic, and the data received from autopsy reports is of particular importance, as toxicology reports can identify when new drugs are involved. Because of this, it should be noted that the Centers for Medicare and Medicaid Services (CMS) recently undermined the Medicare autopsy policy, which encouraged hospitals to do autopsies in certain situations. The pathology and medical examiner community, supported by ASCP, CAP, and the National Association of Medical Examiners (NAME), urged CMS to maintain the policy. A letter from ASCP President Gene P. Siegal to CMS noted, “CMS’s new autopsy policy of deferring to state laws governing the performance of an autopsy is woefully insufficient and does not adequately protect patient health.”⁹

4. Why is this bill important?

By expanding existing programs and creating new residency positions specifically to train physicians in the various aspects of addiction treatment, this bill will increase the number of providers that are greatly needed to prevent and treat addiction. While it is one piece in fighting the crisis, supporting this bill recognizes the importance of needed expertise and resources to stem the tide of the opioid epidemic. 

“As we grapple with the devastating consequences of the opioid epidemic, we know that hospitals need more doctors trained in addiction and pain management in order to treat substance misuse and prevent patients from becoming addicted to opioids in the first place,” said Senator Hassan in a recent release.⁶

5. When will the bill pass?

The bill has already passed the Ways and Means Committee, but as of this writing has yet to be considered by the full House of Representatives or Senate.  

References

1. www.ncbi.nlm.nih.gov/pmc/articles/PMC5993682/
2. www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates
3. www.hhs.gov/about/news/2017/10/26/hhs-acting-secretary-declares-public-health-emergency-address-national-opioid-crisis.html
4. www.hhs.gov/about/news/2019/09/04/trump-administration-announces-1-8-billion-funding-states-combating-opioid.html
5. www.forbes.com/sites/claryestes/2019/12/09/the-opioid-workforce-act-hopes-to-increase-ranks-in-fighting-the-opioid-epidemic/#139d70ae158e
6. www.hassan.senate.gov/news/press-releases/senators-hassan-collins-introduce-bipartisan-bill-to-train-more-doctors-in-substance-misuse-recovery-and-prevention
7. www.aacc.org/health-and-science-policy/advocacy/position-statements/2019/stopping-the-opioid-epidemic-integral-role-of-clinical-laboratorians
8. www.cdc.gov/drugoverdose/foa/state-opioid-mm.html
9. ascpcdn.s3.amazonaws.com/static/public-policy/ASCP+Ltr_Repeal+of+CoP+Autopsy+Rule+Final.pdf