'Drug courts,' treatment focus of new White House opioid strategy

(HealthDay)—Steering opioid addicts toward treatment programs instead of prisons, while tightening federal policies on opioid prescribing, could curb the opioid epidemic, President Donald Trump's opioid crisis commission said Wednesday.

To that aim, the commission's final report recommends that federal drug courts be established in all 93 federal judicial districts, with people who violate their probation diverted into a drug court rather than sent to jail.

Drug courts are problem-solving courts that work with the mental health, social service and treatment communities to help addicted offenders into long-term recovery programs.

Drug courts "are a proven avenue to treatment for individuals who commit non-violent crimes," the commission report states, but 44 percent of U.S. counties do not have drug courts for adults.

"It's an ambitious recommendation, but one that we think, given the success that's happened with drug courts across the states, would be a twofold benefit to the federal justice system," said commission chairman Gov. Chris Christie (R-N.J.). "One, to get help to people who need it in order to slow down recidivism, and secondly it will lower the federal prison population, which I think would allow us to spend those resources" on other important matters.

One addiction expert believes there's also a silver lining to the approach.

"The commission's recommendation that people with substance use disorder be diverted into drug courts instead of prison is a positive step, and a humane response to this crisis," said Dr. Timothy Brennan. He is director of the Fellowship in Addiction Medicine Program at the Addiction Institute at the Icahn School of Medicine at Mount Sinai in New York City.

"It is clear that we cannot and should not jail our way out of the opioid crisis," Brennan continued. "Drug courts have proven to be successful, and it's reassuring that the commission seems to agree."

The panel also is recommending that providers monitor prescription drug databases to ensure that patients or addicts aren't "doctor shopping" for prescription drugs or handing in fake prescriptions.

The panel also wants to see an increase in electronic prescribing to aid in these efforts.

The commission's final report comes a week after Trump declared the opioid epidemic a public health emergency.

"As Americans, we cannot allow this to continue," Trump said last week in a speech from the White House. "It is time to liberate our communities from the scourge. We can be the generation that ends the opioid epidemic."

The new report also proposes expanded block grants to states for opioid and substance abuse activities, as well as measures that would promote better reimbursement of substance abuse treatment by Medicare, Medicaid and other federal health programs.

Other policies that the commission believes could help prevent opioid addiction include:

• Modification of Medicare and Medicaid rate-setting policies that discourage the use of non-opioid treatments for pain.
• Improved policies to ensure informed patient consent prior to receiving an opioid prescription for chronic pain.
• Development of a national curriculum and standard of care for opioid prescribers.
• A requirement that all opioid prescribers undergo continuing medical education on the drugs' prescription before they receive a license renewal.
• Empowering pharmacists to detect and deny fake or illicit opioid prescriptions.
• Improved medical training on screening for substance abuse and mental health problems, to identify at-risk patients.
• Prescription drug-monitoring programs also would continue to be implemented and streamlined under the commission's plan, which also calls for improved forensics and toxicology procedures to better identify drug-related deaths.

Law enforcement still plays a role in this new strategy, however. The commission recommends enhancement of federal sentencing penalties for trafficking of fentanyl and fentanyl-like drugs.

In addition, the report asks the U.S. Drug Enforcement Administration to target cartels who sell fake opioid prescription drugs, and regulate the use of machines that produce pills or tablets.

Although the commission promotes addiction treatment, Brennan was concerned that the money needed to fund these programs might not become available.

"While many of the recommendations could mitigate this crisis, the report still doesn't address additional funding to train the addiction physicians who are desperately needed to treat the growing number of patients," Brennan said.

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