Wednesday, August 10, 2016

New Legislation Seeks to Address National Opioid Concerns

by: Robert Cooper with White Arnold and Dowd

Opioid abuse and misuse is an urgent, nationwide public health concern, and Alabama is no exception to the growing trend. In 2015, Alabama had 1.2 opioid prescriptions per capita—the highest rate in the nation. The Executive Director of the Alabama Board of Medical Examiners recently noted there are currently 496 pain clinics in Alabama. While the nationwide average of abusers of patients receiving opioids is 4.5%, a recent study by Castlight Health, a national insurance information company, identified Anniston, Alabama as having the highest percentage of abusers of opioids in the United States: 11.6%. Anniston shared the top spot with Wilmington, North Carolina. Two other Alabama cities— Gadsden (ranked seventh) and Tuscaloosa (ranked eleventh) – were also identified by the study.

Methadone has been a frontline treatment in the fight against opioid addition. Alabama currently has 24 opioid treatment centers, sometimes called “methadone clinics.” However, methadone is also subject to abuse and must be monitored closely. In 2013, Alabama’s Certificate of Need Review Board imposed a moratorium on the opening of any new clinics for three years, apparently to assess the efficacy of the treatment and outcomes. While the moratorium has since been lifted, the Alabama Department of Mental Health is employing a new geographic formula that prevents a new clinic form opening within 50 miles of an existing clinic, effectively blocking new facilities in any Alabama county except for Lee.

On a national level, in response to this issue of primary concern President Obama signed Senate Bill 524 into law on July 22, 2016. Known as the Comprehensive Addiction and Recovery Act of 2016 (“CARA”), the bill enjoyed bipartisan support and passed both houses of Congress with a wide margin: 407-5 in the House and 92-2 in the Senate.

CARA is wide-ranging and seeks to address the opioid abuse and misuse issue on several fronts. A section-by-section analysis can be found on the website of the National Association of State Alcohol and Drug Abuse Directors. Some of the highlights are: 

  • Enhancing healthcare professionals' use of opioid risk reporting tools and state prescription drug monitoring programs in Department of Veterans Affairs (“VA”)facilities, as well as strengthening education and training on pain management and safe opioid prescribing practices for practitioners, mandating the establishment of clinical teams to coordinate pain management therapy for patients with pain that is unrelated to cancer;  

  • Creating a pilot program to support family-based services for pregnant and postpartum women with a primary diagnosis of a substance use disorder, including opioid use disorders; 

  • Studying the prevalence of neonatal abstinence syndrome (“NAS”), as well as the care settings in which infants with NAS are treated, encouraging “best practices” for treating infants born addicted to opioids, the reimbursement methodologies and costs associated with such treatment, and other related issues; 

  • Authorizing multiyear funding for the Department of Justice to issue grants to states, local governments and Indian tribes to be used to develop or expand treatment alternatives to incarceration programs, train law enforcement officers and other first responders in the use of naloxone to reverse an opioid overdose; 

  • Authorizing the Department of Health and Human Services (“HHS”) to establish grant programs to support co-prescribing opioid overdose reversal drugs for patients who are at increased risk for overdose, including those who are taking prescription opioids, and to develop standing orders for use of opioid overdose reversal drugs for pharmacies and encourage pharmacists to dispense the drugs pursuant to such orders; 

  • Allowing partial filling of opioid prescriptions where not prohibited by state law;  Modifying existing regulations to permit nurse practitioners and physician assistants to administer medication-assisted treatment for opioid use disorder in collaboration with or under the supervision of a qualifying physician (where state law requires such physician oversight).  

  • Directing HHS, together with the VA, the Department of Defense and the Drug Enforcement Administration, to convene a task force composed of representatives from the public and private sectors -- including physicians -- to review, modify and update best practices for pain management and prescribing pain medications.

Now that CARA has become law, healthcare professionals engaged in the delivery of care for patients with chronic pain issues or for those patients struggling with opioid abuse or misuse should anticipate continued close monitoring by the attendant regulatory boards. While significant, the treatment funding aspects for CARA were not close to the $920 million sought by the Democrats supporting the legislation; further discussion and efforts for increased funding in fiscal year 2017 and beyond are anticipated. Healthcare professionals will need to watch carefully for new rules on implementation, regulations, and grant opportunities.


[1] Yurkanin, Amy, “During opioid epidemic, Alabama cracked down on treatment centers,” June 7, 2016, available at (last visited Aug. 8, 2016). 


[1] Id. 


[1] The cited study by Castlight Health identified abusers “as those who received more than a 90-day supply and had received opioid prescriptions from four or more providers in five years, excluding cancer patients and others near the end of life.”  Yurkanin, Amy, “Study: Alabama city leads in opioid abuse among workers,” April 20, 2016, available at (last visited Aug. 8, 2016).


[1] Id. 

[1] Id. 


[1] Id. 


[1] Yurkanin, Amy, “During opioid epidemic, Alabama cracked down on treatment centers,” June 7, 2016, available at (last visited Aug. 8, 2016).


[1] Id. 


[1] Public Law 114-198.



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