Public Health Federal Funding Request to Address the Opioid Epidemic

Public Health Federal Funding Request to Address the Opioid Epidemic On December 4, 2017, in response to the President s recent declaration of the opioid epidemic as a public health emergency and the final report of the President s Commission on Combatting Drug Addiction and the Opioid Crisis, the Association of State and Territorial Health Officials (ASTHO) called on the President and the Congress to provide an additional $1 billion to CDC over two years to expand and strengthen state and territorial capacity to respond to the opioid crisis specifically requesting $1 billion in supplemental funding at CDC. State and territorial health agencies are on the front lines of responding to the current crisis of substance misuse, addiction, and drug overdose. Major federal investments in treatment and recovery should also be complemented with funding for prevention. Preventing individuals from using opioids or other illicit substances in the first place is the best way to end our nation s epidemic. The ASTHO proposal is intended to supplement other critical federal programs at NIH, SAMHSA, FDA, DOJ, VA and other agencies, by focusing on critical funding gaps in prevention programs traditionally supported through CDC. ASTHO applauds the recent bi-partisan budget agreement between the President and Congress that includes at least $3 billion in new funding in both FY 2018 and FY 2019 to combat the opioid epidemic. Of this additional funding, ASTHO strongly recommends that Congress provide $500 million in FY 2018 and the same or greater amount in FY 2019 in additional funding to be spent by the Centers for Disease Control and Prevention (CDC) and state, local, territorial, and tribal health departments to accomplish the following activities: Improve Monitoring and Surveillance ($175 million per year) Strengthening public health surveillance to improve our understanding of the epidemic. Expand and Strengthen Evidence-Based Prevention and Education Strategies ($25 million per year) Expanding CDC opioid misuse and addiction prevention campaigns aimed at providers, supplemented by local education campaigns supported through state grants. ASTHO supports the effort of a national media campaign that is proposed to be funded separately in the HHS Office of the Secretary. Manage Access to Opioids ($250 million per year) Linking electronic health records and prescription drug monitoring programs (PDMPs). Expanding partnerships and collaboration with law enforcement. Improve Access to and Use of Effective Treatment Recovery and Support ($50 million per year) Expanding access to naloxone and linking patients to services including medication assisted treatment. In general, about 80 percent of the funding total is recommended to be allocated to state, local, territorial and tribal health agencies and tribal organizations, and the remaining portion would be expended by the CDC intramural program. This additional funding will spur critical activities to rapidly respond to the opioid epidemic and does not preclude the need for Congress to provide sustained, continued, and increased investments in CDC, 1

SAMHSA, or other agencies at HHS to continue to address the ongoing opioid epidemic. This funding should not be offset by cutting other public health programs. Funds for states and local health agencies could be allocated through the Cooperative Agreement for Emergency Response: Public Health Crisis Response, a recently developed flexible CDC funding mechanism designed specifically to allow states the ability to rapidly apply for and receive funds to respond to urgent public health threats, which can be easily tailored to respond to the opioid crisis. The recent program announcement was published by CDC on Oct. 11, 2017, and applications were Dec. 11, 2017. Funds could be allocated to states through a formula that uses data and measures related to the opioid epidemic, allowing funding to be targeted according to where the need is greatest. In addition to this funding mechanism for states, a similar approach would be used to fund territories and tribal organizations. There is an urgent need to prevent opioid use through population-based and communitywide public health programs including connecting Prescription Drug Monitoring Programs (PDMPs) with electronic health records, surveillance, implementation of prescribing guidelines, and prescription drug public awareness campaigns. Improve Monitoring and Surveillance This would strengthen understanding of the epidemic, including expanding surveillance activities to include syndromic surveillance data from all funded states; initiating surveillance activities on linkages to treatment and other risk reduction services as well as drug product surveillance; linking PDMP data to mortality data; and further increase the timeliness of morbidity and mortality data. These important activities would also strengthen collaborations and support among public health and other stakeholders at the state and community level by enhancing both timeliness and comprehensiveness of surveillance efforts with medical examiner/coroner reporting to better identify the causes of death, allowing for more targeted and focused response to changes in the epidemic. Expand and Strengthen Evidence-Based Prevention and Education Strategies CDC s Rx Awareness campaign tells the real stories of people whose lives have been torn apart by prescription opioids. The goal of the campaign is to increase awareness that prescription opioids can be addictive and dangerous. The campaign also strives to decrease the number of individuals who use opioids recreationally or overuse them. Recommendation #5 in the Commission s report highlights that there are not yet strong data on mass-media campaigns on prescription opioids, heroin, and other opioids, but that a mass media campaign could be modeled on alcohol and tobacco prevention successes. Funding to support an ongoing mass-media campaign to increase awareness that prescription opioids can be addictive and dangerous is an important national-level support that would undergird other prevention policies. ASTHO strongly supports the additional investments for national media campaign proposed to be funded in the HHS Office of the Secretary. Additionally, funding at the state and territorial level is needed to identify and address local perceptions and information gaps in an effective, culturally relevant fashion, to support school-based prevention work. States can use their CDC grants under the ASTHO proposal to supplement the Secretary s national media campaign. CDC will continue and expand critical provider education to reduce prescribing of opioids. Manage Access to Opioids Link Electronic Health Records and Prescription Drug Monitoring Programs (PDMPs) 2

States are still in need of support to continue integrating PDMPs into systems that providers use such as electronic health records (EHR), allowing physicians to delegate access to these records by other health professionals in their office, and expediting registration for providers. PDMP-EHR integration makes accessing PDMP information easier and faster by integrating data in the daily work flow of prescribers in hospitals and physician offices and into the EHR systems used by emergency departments, hospitals health record systems, pharmacy dispensing systems, and others. This work would build upon efforts already occurring in some states to support PDMP-EHR integration and expand the work nationally. To ensure consistency and efficiency of state efforts, a national organization should be funded to provide technical assistance and expedite implementation of state and territorial actions to accomplish this goal. The Commission s report includes this activity as Recommendation #14: PDMP data integration with electronic health records, overdose episodes, and SUD-related (Substance Use Disorder) decision support tools for providers is necessary to increase effectiveness. Expand Partnerships and Collaboration with Law Enforcement This would increase coordination between public health and public safety by expanding CDC s work with High Intensity Drug Trafficking Areas (HIDTA) and management of the Heroin Response Strategy, as well as expanding the number of HIDTAs and reach of existing HIDTAs. CDC currently supports 10 HIDTAs and could scale this work across all 28 HIDTAs. This work seeks to leverage public health and public safety data to create interventions that work across law enforcement, healthcare, treatment, and prevention. Improve Access to and Use of Effective Treatment Recovery and Support Naloxone is a life-saving opioid antagonist and should be readily available to first responders across the country. States sometimes face barriers accessing the drug due to higher prices. Large variances exist across the country when it comes to availability of naloxone in pharmacies. Funding to states will allow increased access to the life-saving drug. Additionally, when someone experiences an overdose and is revived using naloxone, this may be an opportunity to discuss the possibility of treatment. Funding for medication-assisted treatment should be supported through a state and territorial level coordination and referral service for individuals seeking care and immediate referral to treatment. States need to support models that allow patients the best possibility of accessing treatment when they are ready, such as using telehealth and telemedicine. Training to support peer and coach recovery models should be expanded. Proposed allocation of funding: CDC: $100 million State health agencies: $390 million Tribal and territorial health agencies: no less than $10 million (2% set-aside) Total: $500 million CDC would develop a state grant allocation formula based on the burden of the epidemic. For illustrative purposes the hypothetical runs of two options are presented below. Option 1 would allocate funds using a formula based 80% on the state opioid death rate per 100,000, 3

and 20% on total state as a percentage of all U.S.. Option 2 would shift to a 50:50 formula of these two factors. No less than $10 million would be provided for territorial and tribal health agencies. Potential CDC allocation of opioid grants to states based on burden Hypothetical grant amount ($ in millions) Option 1 Option 2 Based on 80% death rate/20% total Based on 50% death rate/ 50% total Rank 2016 Number of opioid *2016 ageadjusted rate Alabama 6.9 5.9 28 756 16.2 Alaska 6.1 3.9 45 128 16.8 Arizona 7.6 7.8 18 1,382 20.3 Arkansas 4.5 3.8 35 401 14.0 California 9.3 17.1 2 4,654 11.2 Colorado.1 6.4 24 942 16.6 Connecticut 79.1 8.0 23 971 27.4 District of Columbia 8.3 5.8 42 269 38.8 Florida 13.4 19.8 1 4,728 23.7 Georgia 5.6 6.9 17 1,394 13.3 Hawaii 4.2 3.1 44 191 12.8 Idaho 4.3 3.3 43 243 15.2 Illinois 8.8 11.0 7 2,411 18.9 Indiana 9.8 9.8 14 1,526 24.0 Iowa 3.4 2.0 39 314 10.6 Kansas 4.4 3.5 40 313 11.1 Kentucky 9.6 9.4 15 1,419 33.5 Louisiana 9.1 8.1 22 996 21.8 Maine 8.4 6.1 36 353 28.7 Maryland 10.3 11.4 11 2,044 33.2 Massachusetts 10.6 12.0 9 2,227 33.0 Michigan 10.7 12.3 8 2,347 24.4 Minnesota 4.8 4.6 29 672 12.5 Mississippi 4.4 3.6 37 352 12.1 Missouri 9.6 9.3 19 1,371 23.6 4

Based on 80% death rate/20% total Based on 50% death rate/ 50% total Rank 2016 Number of opioid 2016 ageadjusted rate* Montana 4.1 2.9 48 119 11.7 Nebraska 3.1 1.4 47 120 6.4 Nevada 8.8 7.1 30 665 21.7 New Hampshire 8.6 6.5 34 481 39.0 New Jersey 10.4 11.4 10 2,056 23.2 New Mexico 8.6 6.6 33 500 25.2 New York 10.2 14.9 5 3,638 18.0 North Carolina 8.2 9.6 12 1,956 19.7 North Dakota 3.1 1.2 50 77 10.6 Ohio 13.0 18.5 4 4,329 39.1 Oklahoma 8.9 7.5 27 813 21.5 Oregon 4.6 4.1 32 506 11.9 Pennsylvania 13.3 19.5 3 4,627 37.9 Rhode Island 8.4 6.0 38 326 30.8 South Carolina 7.0 6.2 26 879 18.1 South Dakota 3.1 1.2 51 69 8.4 Tennessee 9.9 10.1 13 1,630 24.5 Texas 6.2 9.9 6 2,831 10.1 Utah 8.7 7.0 31 635 22.4 Vermont 8.1 5.4 46 125 22.2 Virginia 7.6 7.9 16 1,405 16.7 Washington 5.3 5.9 20 1,102 14.5 West Virginia 9.0 7.8 25 884 52.0 Wisconsin 7.2 6.9 21 1,074 19.3 Wyoming 6.1 3.8 49 99 17.6 TOTAL 390.0 390.0 63,632 *opioid per 100,000 Contact Carolyn Mullen, Chief of Government Affairs and Public Relations at cmullen@astho.org, or Mark Mioduski, Principal at Cornerstone at mmioduski@cgagroup.com. March 1, 2018 5