Congress’ latest opioid law isn’t enough

The ideas and innovators shaping health care

Mar 08, 2023 View in browser   By Ben Leonard, Ruth Reader and Erin Schumaker WASHINGTON WATCH The DEA's Anne Milgram says her agency supports efforts to treat people addicted to opioids with buprenorphine. | Getty Images A new law that makes it easier for doctors to prescribe a lifesaving drug to treat opioid addiction is facing implementation problems. Enacted in December, the law eliminated a requirement that practitioners take a training course to prescribe buprenorphine, which helps patients wean themselves from opioids like fentanyl or heroin. The law also lifted restrictions on the number of patients doctors can treat. Even so: The new law doesn’t mean doctors will take advantage or pharmacies will carry buprenorphine, even though studies have found it reduces the risk of an opioid overdose death by about 40 percent. The Drug Enforcement Administration subjects the drug to such strict regulation that many are reluctant to dispense it. While one government arm tries to expand access, another creates a choke point, said Michael Lynch, a doctor who specializes in addiction medicine: “Only so many of those prescriptions can actually end up getting filled.” “Their medicine is literally on the other side of the counter, and the pharmacist is saying no.” Stephen Martin, head of research and education at Boulder Care Why it matters: Doctors told POLITICO they have trouble getting patients’ prescriptions filled as pharmacies and drug distributors try to avoid running afoul of the DEA. Practitioners experienced in treating opioid addiction told POLITICO there are other obstacles: — Many doctors don’t know the training requirement to prescribe buprenorphine is gone. —There are snags with insurance coverage. — Some states impose their own requirements for doctors to prescribe the drug. Treatment advocates say the government can do more to help reduce opioids’ death toll: more than 80,000 lives in 2021. “Every barrier that someone faces trying to get a lifesaving medicine must be removed,” said Stephen Martin, head of research and education at Boulder Care, a telehealth addiction-treatment clinic. The DEA responds: An agency spokesperson said the DEA is both reaching out to pharmacies and making public statements to encourage the prescribing of buprenorphine, and it is working to identify bottlenecks in the distribution chain.  At a White House event in January, DEA Administrator Anne Milgram called the new law “a game changer,” and acknowledged that “there is more for us to do together.”   DOWNLOAD THE POLITICO MOBILE APP: Stay up to speed with the newly updated POLITICO mobile app, featuring timely political news, insights and analysis from the best journalists in the business. The sleek and navigable design offers a convenient way to access POLITICO's scoops and groundbreaking reporting. Don’t miss out on the app you can rely on for the news you need, reimagined. DOWNLOAD FOR iOS– DOWNLOAD FOR ANDROID.     WELCOME TO FUTURE PULSE Kenilworth Aquatic Gardens, Washington, D.C. | Shawn Zeller This is where we explore the ideas and innovators shaping health care. A new discovery by Harvard Medical School researchers suggests that gut microbes could someday be harnessed to help people recover from injuries. The study in mice found that microorganisms in the mice's gastrointestinal systems produced T cells that acted as "sentries that sense damage at distant sites in the body and then act as emissaries to repair that damage,” senior author Diane Mathis told The Harvard Gazette. Share any thoughts, news, tips and feedback with Ben Leonard at bleonard@politico.com, Ruth Reader at rreader@politico.com, Carmen Paun at cpaun@politico.com or Erin Schumaker at eschumaker@politico.com. Send tips securely through SecureDrop, Signal, Telegram or WhatsApp. Today on our Pulse Check podcast, your host Ben talks with Megan R. Wilson about a handful of small companies developing next-generation Covid-19 vaccines that hired lobbyists in hopes of winning contracts to fund research, manufacturing and testing and why the drugmakers are now abandoning Washington. Listen to today’s Pulse Check podcast THE REGULATORS Biden adviser Anne Neuberger wants government-mandated cybersecurity standards. | Alex Wong/Getty Images Health care organizations have a new HHS guide to help bolster their cyber defenses. For now, compliance with the manual is voluntary. But the advice comes a week after President Joe Biden’s deputy national security adviser for cyber and emerging technology, Anne Neuberger, said she thought health care organizations should be required to meet some sort of minimum cybersecurity standards. There’s support for that among key lawmakers. In January, Senate Intelligence Committee Chair Mark Warner (D-Va.) told Ben that “the amount of damage that’s being done is going to require standards.” Inside the guide: The new HHS roadmap includes best practices and a “common language for tackling cybersecurity.” It’s a guide to implementing 2018 cybersecurity standards developed by the Commerce Department’s National Institute of Standards and Technology. Those standards offered guidance on limiting risk by controlling access to critical systems, monitoring supply chains and keeping tabs on emerging threats. “Health care cyberattacks are among the fastest growing type of cybercrime — jeopardizing patient care, damaging the integrity of health care systems, and threatening the U.S. economy,” said Dawn O’Connell, HHS Assistant Secretary for Preparedness and Response in a statement. State of play: It’s unclear how many health care organizations have taken up the best practices. An April 2022 Government Accountability Office report found that HHS — and several other federal agencies — hadn’t taken steps to determine the level of adoption.   LISTEN TO POLITICO'S ENERGY PODCAST: Check out our daily five-minute brief on the latest energy and environmental politics and policy news. Don't miss out on the must-know stories, candid insights, and analysis from POLITICO's energy team. Listen today.     CHECKUP Veterans in cities were more likely to use telehealth during the Covid pandemic. | AP Telemedicine was used more often by Veterans Affairs health care beneficiaries in rural areas than those living in cities before Covid arrived. But as telemedicine use surged during the pandemic, the script flipped. Fifty-five percent of VA patients in rural areas used telemedicine during the pandemic compared with 60 percent of those in urban ones, according to a new study based on more than 66 million visits through the end of 2021 published Tuesday in JAMA Network Open. The divide was more pronounced for mental health care, the study found. “Widespread telemedicine expansion, without addressing underlying reasons for digital inequity among rural sites, may result in telemedicine uptake among rural areas lagging,” wrote the researchers from UCLA; the University of California, San Diego; the Veterans Health Administration; and others. The researchers suggested:  — Tackling structural barriers to access, such as broadband — “Tailoring technology to encourage adoption” among rural patients — Continuing efforts to boost digital literacy Zooming out: The researchers noted that the rural-urban divide existed despite the VA’s previous efforts to expand care broadly. The agency has long permitted virtual care across state lines and was an early adopter of telemedicine infrastructure. It began distributing electronic tablets to veterans who needed a method of meeting virtually well before the pandemic. But the agency has struggled to implement a new electronic health records system. A VA spokesperson said the agency has a five-year plan to bolster virtual care for rural beneficiaries.   Follow us on Twitter Ben Leonard @_BenLeonard_ Ruth Reader @RuthReader Carmen Paun @carmenpaun Erin Schumaker @erinlschumaker   Follow us

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