“The Commission has been urged by every Governor, numerous treatment providers, parents, and non-profit advocacy organizations to eliminate the IMD exclusion within the Medicaid program,” the commission writes. “This component of the Social Security Act prohibits federal Medicaid funds from reimbursing services provided in an inpatient facility treating ‘mental diseases’ (including SUDs) that have more than 16 beds. This exclusion makes states entirely responsible for Medicaid-eligible patients in inpatient treatment facilities, including patients undergoing withdrawal management in addiction treatment facilities rather than hospitals.”

While the commission concedes that Congress would have to enact legislation to repeal the exclusion in its entirety, the group writes that Department of Health and Human Services Secretary Tom Price could immediately grant waivers to each state that requests one, particularly after Trump makes an emergency declaration.

“This is the single fastest way to increase treatment availability across the nation,” the commission writes.

The group also recommends the federal government mandate prescriber education initiatives with the assistance of medical and dental schools across the country to enhance prevention efforts, and mandate medical education training in opioid prescribing and risks of developing an SUD by amending the Controlled Substance Act to require all Drug Enforcement Administration registrants take a course in proper treatment of pain. HHS should work with partners to ensure additional training opportunities, including continuing education courses for professionals.

The commission cites a Substance Abuse and Mental Health Services Administration Center for Behavioral Health and Statistics Quality report, which found that 4 out of 5 new heroin users begin with nonmedical use of prescription opioids.

“In other words, Mr. President, this crisis began in our nation’s health care system,” the commission writes. “While we acknowledge that some of this inappropriate overprescribing is done illegally and for profit, we believe the overwhelming percentage is due to a lack of education on these issues in our

nation’s medical and dental schools and a dearth of continuing medical education for practicing clinicians. This can and must be solved by using Presidential moral and legal authority to change this lack of education leading to addiction and death.”

The commission did cite a number of initiatives around the country aimed at ensuring that providers are aware of the potential for misuse and abuse of

prescription opioids, including several states’ expansion of continuing medical education requirements for opioid prescribers and dispensers.

“We urge national implementation of these initiatives,” the commission writes, adding that in the group’s first meeting, several nonprofits discussed the need to promote expanded implementation of the CDC Guideline for Prescribing Opioids for Chronic Pain through increased prescriber education initiatives.

The commission also urges Trump to instruct the Department of Justice and the Drug Enforcement Administration to require continuing medical education for every physician requesting an initial DEA license or the renewal of such a license.

Moreover, the CDC and the U.S. Food and Drug Administration should finalize, review and recommend national training standards, working with the Accreditation Council for Continuing Medical Education to ensure training courses are coordinated with other federal agencies, professional societies, medical schools and residency programs to avoid discrepancies.

The FDA should also work with the ACCME to develop data analytics to determine whether courses change practices, increase patient referrals to treatment, and methods to improve compliance consistent with opioid prescribing education, the group says.

“Clinicians need more detailed and specific guidance on drug choice, dose, and quantity to be dispensed in treating specific pain conditions,” the commission writes. “We also recommend a detailed analysis of, and solutions to, clinical problems encountered in applying recommended guidelines.”

The commission also recommends that the government immediately establish and fund a federal incentive to enhance access to medication- assisted treatment, and require that all modes of MAT are offered at every licensed MAT facility and that those decisions “are based on what is best for the patient.” The administration should also partner with the National Institutes of Health and the industry to facilitate testing and development of new MAT treatments.

“MAT has proven to reduce overdose deaths, retain persons in treatment, decrease use of heroin, reduce relapse, and prevent spread of infectious disease,” the commission writes. “Expansion of MAT availability for qualified individuals and for short- or long-term treatment is an essential.”

The commission will issue another report on recommendations in the fall.