Daily on Healthcare: Rural areas behind in the fight against opioids

RURAL AREAS BEHIND IN THE FIGHT AGAINST OPIOIDS: The assistant clinical director of the Southwest Behavioral Health Center in Utah, Angi Edwards-Matheson, faces a major problem in fighting the opioid epidemic afflicting the state’s rural counties: Her treatment center struggles to attract medical professionals.

“It’s hard to recruit people, therapists included, to rural areas,” Edwards-Matheson said. “They don’t want to relocate there. It’s hard to build a practice with very, very small numbers of qualified prescribers, and have it be a successful practice.”

The Southwest Behavioral Health Center’s funding problems are symptoms of a larger problem with the government’s efforts to contain the opioid crisis. Federal funding is allocated mostly to large urban areas rather than small communities such as those in southern Utah. Despite passing sweeping opioid legislation in 2016, Congress has struggled to direct aid to rural counties.

The rate of prescription opioid and heroin-related deaths declined in 2017 by almost 20%. While the decrease in deaths is encouraging, health professionals like Edwards-Matheson are still worried about a lack of resources in the regions her practice serves. She hopes that more funding from the federal government will reach the local and community levels.

A particular problem for rural Utah counties is that they lack authorized healthcare providers to administer buprenorphine, a medication for opioid use disorders that can only be prescribed by a healthcare professional. Many of those who become qualified to prescribe buprenorphine, Edwards-Matheson says, gravitate toward urban centers.

Buprenorphine was a breakthrough when it was introduced in 2002. It allows patients to receive treatment in an office and take a daily medication at home or at the pharmacy rather than go to a methadone clinic. It can help save lives, but not every county in Utah has treatment centers to provide buprenorphine.

Congress passed the Comprehensive Addiction and Recovery Act of 2016 in part to provide small and rural towns the same access to treatment drugs as bigger communities such as Salt Lake City, but three years later, the effort hasn’t panned out.

One provision of the law meant to help rural areas is authorizing nurse practitioners and physician assistants to prescribe buprenorphine for five years. With a Drug Enforcement Administration-approved waiver and at least 24 hours of training, nurse practitioners and physician assistants would be authorized to save lives of addicts in the most remote areas.

Sen. Rob Portman, R-Ohio, introduced an updated bill for addiction recovery in May 2018. It would add funding for recovery resources in rural and underserved areas. “We have the opportunity to build on this effort, increasing funding levels for programs we know work and implementing additional policy reforms that will make a real difference in combating this epidemic,” he said in a statement.

The bill, dubbed “CARA 2.0,” authorizes a total of $1 billion in resources to prevention, research, education, and enforcement. Much of the funding will go toward first responder training and expanding the study of medication-assisted treatments.

It also includes a provision that President Trump signed into law as part of separate opioids legislation in November 2018, allowing nurse practitioners and physician assistants to prescribe medication-assisted treatment for an unlimited amount of time, rather than for just five years.

Good morning and welcome to the Washington Examiner’s Daily on Healthcare! This newsletter is written by senior healthcare reporter Kimberly Leonard (@LeonardKL) and healthcare reporter Cassidy Morrison (@CassMorrison94). You can reach us with tips, calendar items, or suggestions at [email protected]. If someone forwarded you this email and you’d like to receive it regularly, you can subscribe here.

MARK YOUR CALENDARS: The Washington Examiner is hosting its next “Examining Healthcare” event on Wednesday May 1 at 8 a.m. The event will feature interviews from Kimberly with Sens. Bill Cassidy, R-La., and Doug Jones, D-Ala. Breakfast is provided. Register here.

MONTANA ON ITS WAY TO MAINTAIN MEDICAID EXPANSION: The state Senate on Monday advanced a bill to extend the Medicaid expansion just in time for a deadline to send the provision over to the state House. The bill adds a tax to hospitals, work requirements for certain enrollees, and premiums for people who stay on the program for more than two years.

Montana is different than other states that expanded Medicaid. Rather than do so outright, it set a deadline to find funding to pay for the state’s portion. Voters had the opportunity in November to authorize a tobacco tax to cover the difference, but the ballot was defeated with significant investment from the tobacco industry. Without new funding, the program is set to expire June 30, which would cause 96,000 people to lose coverage.

NEVADA ADVANCES PROTECTIONS FOR PRE-EXISTING CONDITIONS: The Nevada Senate unanimously passed a bill extending protections for pre-existing conditions created by the Affordable Care Act to state law Monday and the bill will move on to the Assembly. “If we should unfortunately lose the coverage that we have at the national level … we need to make sure that at least in Nevada we will not discriminate against anyone based on their health status,” Democratic Sen. Julia Ratti said in her introduction of the bill.

CMS TO LAUNCH COMPREHENSIVE REVIEW OF NURSING HOMES: Centers for Medicare and Medicaid Services Administrator Seema Verma announced a new five-part plan Monday to review regulations, guidelines, internal structure and safety in nursing homes. The plan includes strengthening oversight of nursing homes’ safety and quality, enhancing enforcement of safety and quality requirements, increasing transparency in choosing a nursing home, improving quality, and putting patient care ahead of paperwork administrative tasks.

NURSING GROUP CALLS FOR TREATMENT RATHER THAN INCARCERATION FOR PREGNANT WOMEN WHO USE DRUGS: The American Academy of Nursing released a policy brief Monday petitioning for an end to criminal prosecution against pregnant women with substance abuse disorder. As the opioid epidemic rages on, pregnant women are often incarcerated rather than referred to treatment. The Academy recommends more funding for SAMHSA as well as community-based outreach and treatment centers.

ONE WOMAN’S PATH TO ‘PROFOUND GRATITUDE’ FOR LIFE AFTER HER HUSBAND SUFFERED A MAJOR BRAIN INJURY: Abigail Maslin has been a full-time caregiver to her husband TC after he was assaulted in the street in 2012, sustaining a traumatic brain injury. She discussed her new role of taking care of her husband and young son, both entirely dependent on her. Caregivers, she said, are also survivors, but rarely feel they can voice the trauma they endured as well and cannot heal themselves. She shared her own process of healing, as well as that of her family.

PARENTS SUE AGAINST BROOKLYN’S VACCINE MANDATE: Five mothers filed suit against the New York City Department of Health for mandating vaccinations in specified areas of Williamsburg, Brooklyn last week. Mayor Bill de Blasio issued an order which requires children starting at six months up to school age to be vaccinated if they live or attend school in these specified zip codes. The mothers call de Blasio’s order “arbitrary and capricious.”

MEASLES CASES RISE GLOBALLY AT THE START OF 2019: The number of measles cases grew 300 percent in the first three months of 2019, according to the World Health Organization. While the data is preliminary and subject to change, WHO reports that considerable spikes were seen in countries that usually have high-vaccine coverage, including the United States, Israel, Thailand, and Tunisia.

AOC CALLS SOCIAL MEDIA A PUBLIC HEALTH RISK: Rep. Alexandria Ocasio-Cortez, D-N.Y., said in an interview Sunday with Yahoo News that she quit Facebook and is reducing her screen time on social media outlets which she described as a “public health risk” which can lead to “increased isolation, depression, anxiety, addiction, escapism.”

WASHINGTON STATE WEIGHS LAW TO RECKON WITH NATIVE AMERICAN HEALTH PROBLEMS: The Washington state legislature unanimously voted Thursday to advance The Washington Indian Health Improvement Act which would mandate that a healthcare improvement plan for Washington’s Native Americans be made every two years. The bill is headed to Gov. Jay Inslee’s desk for his signature. The Native American community has recently struggled to combat health conditions including drug overdoses, suicides, diabetes, and hypertension.

The Rundown

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The Hill Sanders town hall audience cheers after Fox News host asks if they’d support ‘medicare for all’

The Washington Post Unaware he had measles, a man traveled from N.Y. to Michigan, infecting 39 people

CNN Researchers 3D-print heart from human patient’s cells

Nashville Public Radio Hackers’ Favorite Target Is Now Health Care, Report Finds

Calendar

TUESDAY | April 16

House and Senate in recess.

WEDNESDAY | April 17

Noon. Dirksen G-50. Alliance for Health Policy event on “Right Care, Right Patient, Right Time: The Role of Comparative Effectiveness Research.” Details.

Noon. SD-G11 Dirksen. Council for Affordable Health Coverage event on “The ABCs of Medicare Part B: Affordability Challenges for Physician-Administered Drugs & Proposals for Reform.” Email [email protected] to RSVP.

THURSDAY | April 18

Noon. 215 Massachusetts Ave. NE. Heritage Foundation event on “Tell Your Children: The Truth About Marijuana, Mental Illness, and Violence.” Details.

MONDAY | April 22

April 22-25. Atlanta. Rx Drug Abuse and Heroin Summit. Agenda.

5 p.m. 1775 Massachusetts Ave. NW. Brookings conversation with author Dr. William A. Haseltine on “World Class: A Story of Adversity, Transformation, and Success at NYU Langone Health.” Details.