Recovery Army Solutions

Pharmaceutical Industry

Financial Incentives Removed for Prescribing and Direct Marketing of Pharmaceuticals

• Remove pharmaceutical advertisements from TV/Cable/Media.
• AMA Calls for Ban on Direct to Consumer Advertising of Prescription Drugs and Medical Devices²⁹
• Re-evaluate the Medicare physician/ER visit billing guidelines and remove the medical decision/risk making incentive to write a script during a patient visit.
• Truth and Trust: Virtually everything we know about drugs is what the companies have chosen to tell us and our doctors…the reason patients trust their medicine is that they extrapolate the trust they have in their doctors into the medicines they prescribe.

Institute Transparent Commission to Study Schedule III & IV Drugs
Renewed outlook with new evidence based data of dependence, addiction, misuse and/or abuse.
Examples: Benzodiazepines, Valium, Darvon, Ativan, Xanax, Soma.

Electronic Script Pads
Eliminating prescription pads is critical in removing the ability for fraud. We need to move completely to an Electronic Prescription Orders Program which has proven to be a safer and more secure method from the prescriber to the dispenser.

• The regulations provide pharmacies, hospitals, and practitioners with the ability to use modern technology for controlled substance prescriptions while maintaining the closed system of controls on controlled substances.^{14, 15, 16}

Best Practices Prescribing Guidelines for All Controlled Substances, Not just Opioids
We must establish standards and best practices for managing pain, and support the CDC’s efforts to improve “Opioid Prescribing Guidelines.” We need transparency and efficacy at the FDA. No longer can we accept high volumes of addictive opiates to be prescribed to our citizens, particularly, our youth. We must look at all providers across all specialties. This is about “controlling” controlled substances in EVERY instance, regardless of the patient diagnosis.

Medical Standards of practice currently vary state to state because “medicine” is regulated by each state individually and not by the federal government. Therefore, we must immediately demand and require that all controlled substance prescribers participate in mandated “transparency” education.

• Broader Strategies Urged to Counter Painkiller Over-Prescribing
• Transparency only policy
• ALL 3^rdparty payers must come to the table as the controlled substance overprescribing epidemic crosses all patients and payers.
• America’s painkiller epidemic grips the workplace while opioid prescribing plan lacks guidance on workers comp issues
• Wide Disparity in Opioid Doses in Veteran Overdoses¹⁷
• Benzodiazepines: Sedative-Related Overdoses on the Rise – Starrels and colleagues used data that tracks drug prescriptions and drug overdoses. They found the number of adults who used benzodiazepines rose from 8.1 million prescriptions in 1996, to 13.5 million in 2013- a67 percent increase. The quantity of filled prescriptions more than doubled during that period.
• Adderall: Nonmedical Use of Adderall on the Rise Among Young Adults – with a 67 percent increaseamong young adults between 2006 and 2011.
• Kids on Anti-depressants: The number of children prescribed antidepressants to combat suicidal thoughts has soared in the past decade despite guidelines saying that their use should be limited.

Insurance Companies

Mental Health Substance Use Disorder Insurance Reform
We need to review insurance practices that impede access to addiction treatments, including long-term care. This is one of the most fundamental parts of how we will overcome this epidemic.

• Mental Health Parity Act 2008 enforcement³
• Anthony’s Act, which calls for 90-day minimum inpatient treatment must be approved and implemented immediately. Today’s 28-day “standard” is a massive failure with death and relapse being the outcome.⁴
• Outpatient “fail first” insurance standard in fact causes harm to the patient, we must insist on immediate change to this policy.
• Requirement for a “positive” drug screen to meet insurance industry criteria in fact encourages morbidity and mortality of those seeking help.

Change HIPAA Laws to Protect Addicts and Families
The HIPPA law protects the medical records of “emancipated minors,” and prevents parents, family members or friends from gaining access to medical information. This exists unless explicit permission is given by the patient to their loved ones. However, many addicts make deliberate efforts to hide their medical records from their parents to cover up their drug abuse.

In some ways, HIPPA hurts patients by preventing families from understanding the realities of the addict’s disease. With young adults now allowed to remain on a parent’s insurance until age 26, this law must be changed to protect the lives of youth and young adults who are suffering from the disease of addiction. It must be changed to protect the lives of ALL who suffer from this disease.

Does HIPAA help or hinder a patient’s medical/mental healthcare? – Rep Tim Murphy (PA) resolutions/solutions⁵

Treatment Providers

Medication Assisted Treatment (MAT)
Utilize medication assisted treatment, such as Buprenorphine and Vivitrol with a clear understanding of the benefits, limitations and the risks. This treatment should not be used as a standard without provider monitoring and treatment/recovery assistance. We must not allow profits to trump patient safety and dictate success. We MUST honestly assess and study further those that rely on this for long-term treatment with a transparent risk versus benefit analysis.

• Immediately reduce barriers to buprenorphine with mandatory requirement of physician counseling and monitoring.
• Provide immediate access to Naltrexone shots, pellets and / or implants

Alternative and Holistic Treatment
We must look at at ypical treatments such as Ibogaine which should NEVER be discounted simply because they’re unusual. We must allocate the resources for transparent scientific studies.

Medical Approach to Detox/Treatment on Demand
Barriers to medical care must be eliminated, we must help people in need of treatment find and access necessary services.

• It is imperative that both the medical and criminal justice communities have the most accurate and up to date information about treatment options and resources. This information needs to be immediately accessible without delay.
• We must assist and educate substance use disorder patients and their families to navigate the human services system and managed care systems as well.

Federal, State, and Local Governments

“Smart” Approaches to Marijuana Legislation Nationwide

• DO NOT Legalize Marijuana for Recreational Purposes
• Reverse State laws that have countered this Federal statute
• Remove Marijuana from Schedule 1 to Schedule 2 and push the FDA to proactively and aggressively study the medicinal effects of THC and CBD
• Develop SMART Approaches to medicinal marijuana that does NOT allow widespread availability which increases adolescent use of this drug

Perform a Complete Treatment “Industry” Overhaul

• Medical standards of care
• Continuum of care
• Global change of “client” to “patient”
• Informed consent
• Patient Bill of Rights
• Mental Health Parity Act 2008

Federal Prescription Drug Monitoring Program (PDMP)
Prescriber controlled substance education and use of PDMP MUST be linked to the DEA registration with urgent ramifications for non-compliance. Taking full advantage of the inherent and data proven, morbidity and mortality reducing outcomes of the PDMP. Linking this to the DEA eliminates the need for medical regulations by individual states. This is a national crisis and must be treated as such by the prescribing community.

• Resources to immediately implement state-of-the-art technology to detect and deter prescription drug addiction. This must be real-time reporting with intestate sharing of prescription drug data.
• PDMP Access and Registration Information¹³

Medical / Dental Provider / Student Education Laws
We need to offer mandatory continuing education for all health care professionals to stay abreast of changing trends and/or medical advancements in substance use disorder treatment and controlled substance prescribing.

This must be done in partnership with the state’s medical schools to establish a continuing education program ensuring prescribers and other substance use disorder treatment professionals possess the most current and valid information on pain management, controlled substance prescribing, opioid misuse/abuse, and suicide prevention.

• How to Prevent Opioid Abuse: Training and Education¹⁸
• Stop the Stigma and Expand Access to Comprehensive Treatment¹⁹
• Steps Physicians Can Take²⁰
• Medical/Nursing/Pharmacy Schools and all Allied Health Care Related professions
• Transparent mandatory substance use disorder, addiction and controlled substance prescribing training
• Transparent education of prescribers and community of ADF’s with emphasis on the fact that ADF’s DO NOT mitigate risks of addiction. We must send a very clear message that “abuse” is NOT required for becoming addicted. Taken as prescribed leads to narcotic dependency, addiction, and overdose.

Good Samaritan Laws
Expansion and increased community awareness thru better educational programs on the “Overdose Protection Act”. This law protects users from prosecution for calling 911 to save the life of another user. Instituting a Federal Good Samaritan Law, so that every state protects those that contact 911 to save the life of an overdose victim, is the most expedient way to this means.

• Good Samaritan Law and Legal Definition²¹

Rescue Drug Laws
Naloxone MUST be readily available not only to law enforcement officers, but to every family that is dealing with a user in the grips of legal opioids or heroin addiction, in every school and in every jail. This will immediately save lives.

• McGreevey: Addicts need treatment more than jail (Opinion)²²
• Naloxone for Opioid Safety ²³
• Pennsylvania: Heroin overdose drug naloxone to be provided free to all PApublic schools²⁴
• New York: Naloxone being made available over the counter in NYC²⁵
• AMA: Increasing Access to Naloxone: Help Save Lives from Opioid Overdose²⁶

Civil Protection of Addicts
We MUST institute laws that allow medical and law enforcement personnel to consider an opioid drug poisoning survival victim as a danger to themselves and others like we do those who have attempted suicide (Mental Health Parity). Without this, drug poisoning victims are released without intervention. ALL drug poisonings MUST be treated by one standard of care, regardless if legal or illegal, including involuntary commitment.

• Baker Act/Marchman Act/Section – to be “usable” and “applicable” by all with no
  financial barriers²⁷
• Can probation be transferred across state lines?²⁸

Laws to Fight Distribution
Improve weight to dosage laws by lowering the weight where criminal justice consequences attach with adequate penalties that are appropriate for high volume drug dealers. The amount of heroin it takes to warrant serious criminal penalties is much greater per dosage than other drugs. There needs to be some sort of deterrence to dealing heroin in suburban and rural America as well as urban America.