The President’s Commission on Combating Drug Addiction and the Opioid Crisis, established by an executive order from President Trump, issued its draft report. In brief, plain language, the commission calls on the president to act swiftly and decisively to declare a national emergency.
Other recommendations include increasing addiction treatment capacity, mandating opioid prescriber education, enhancing access to medication-assisted treatment programs and putting naloxone in the hands of every police officer. None of the recommendations mention the role of, or need for paramedics, EMTs, ambulance companies or EMS agencies to assess and treat patients who have overdosed.
Written as a letter to “Mr. President,” the report concludes with an appeal to the president’s empathy and strength of the office. The commission’s letter concludes, “Finally, our country needs you, Mr. President. We know you care deeply about this issue. We also know that you will use the authority of your office to deal with our nation’s problems.”
The commission’s draft report is worth reading, because it elevates the leading cause of accidental death to the highest level of political and media attention. Here are my top four concerns and takeaways from the report.
1. EMS is not considered or mentioned
The commission draws attention to the many groups – governors, DEA-licensed narcotics prescribers, local and federal law enforcement officers, addiction treatment specialists and other physicians – who will help the president prevail against an epidemic killing more people than the combined deaths from gun homicides and motor vehicle collisions. Conspicuously absent, but not surprisingly so, from the report is any mention of EMTs, paramedics, medical first responders or ambulances.
Even though every EMT and paramedic knows that EMS is on the front lines of the opioid epidemic, our profession has done a poor job of drawing the attention of policy makers, elected officials and other health care providers participating in state or federal commissions. “Facing Addiction,” a report issued by President Obama’s Surgeon General, only makes a couple of passing mentions of access to naloxone for emergency medical technicians. Wisconsin, my home, has a Governor’s Task Force on Opioid Abuse, but there isn’t an EMS representative.
EMS mostly gets fleeting attention from local officials when the eyebrow-raising costs of naloxone administration come before budget committees or city council members. Unfortunately, the data gathering capabilities of EMS, the repeat patient contacts, programs to refer addicts to treatment, use of community paramedics to monitor addicts in recovery and the cumulative stress of treating patients with mental health and addiction problems largely go unnoticed or unheard of by local- or state-elected officials.
2. Naloxone for every POLICE OFFICER
The commission’s draft recommendations make two big requests of law enforcement. First, the commission asks the president to make naloxone available to every law enforcement officer in the country. It’s not stated if this naloxone is for patient care, buddy care or self-care. The commission wants the Health and Human Services secretary to have the authority to negotiate reduced pricing for all governmental units without clarifying if this pricing is only for law enforcement or if the pricing will bring cost-savings to public and private EMS agencies, fire departments and hospitals.
The commission’s second big law enforcement request is for increased funding to hire more Customs and Border Protection officers, FBI agents and DEA agents. There is no argument that disrupting the supply of heroin and fentanyl is of critical importance to resolving the opioid epidemic. But supply disruption needs to go hand-in-hand with treatment efforts to lower demand.
Comments on the commission’s interim recommendations from fire and paramedic chiefs will be critical to ensuring EMTs, paramedics and firefighters are identified in the commission’s final report to the president. It’s critical that naloxone is in the hands of paramedics and EMTs to treat overdose patients. Crime investigation and supply disruption needs to be the top priority of law enforcement, not opioid overdose reversal.
3. Windfall of funding isn’t likely to reach EMS
In addition to more funding for law enforcement personnel and sensors to detect fentanyl at border crossings and shipping facilities, the commission has recommendations for the president to expand funding for prescriber continuing medical education, mental health treatment and medication-assisted treatment. There is even a recommendation to use “big data analytics to devise targeted prevention messages that employ cutting-edge methods of marketing and communications.”
The commission compares the death toll – 142 Americans die every day from the opioid overdose – to Sept. 11 terrorist attacks. By declaring a national emergency, the full strength and purse of the federal government will be available to combat the opioid epidemic.
All of the commission’s recommendations are likely worth consideration and will cost billions to implement and to make an impact. As those billions of dollars are distributed, EMS risks being left out, similar to the post-9/11 windfalls for WMD preparedness, as opioid national emergency funds are distributed to law enforcement, addiction treatment facilities and hospitals.
4. Recommendations are disconnected from rhetorical, political reality
For me, the most striking part of the commission’s draft recommendations, was the disconnect between tone, language and action steps from current rhetorical and political reality. A majority of the House of Representatives and near majority of the Senate has recently voted to decrease funding to Medicaid, yet the commission calls for expanding Medicaid for inpatient treatment of substance use disorders.
The commission also calls on the president to instruct the National Institutes of Health to immediately develop additional medication-assisted treatment options and new non-opioid pain relievers. This is a fine recommendation, but the president’s proposed budget reduced funding to the NIH, CDC and FDA, so new areas of research will either draw from increasing funding or come at the expense of other important disease research.
Include EMS in opioid commission’s final report
The commission plans to release its final report and recommendations to the president this fall. Meanwhile, EMTs, paramedics, firefighters and cops will be on the frontlines of the epidemic. Their needs for funds to purchase naloxone and PPE, test and evaluate programs to refer addicts to treatment or don the most appropriate PPE to reduce exposure risk from fentanyl and other synthetic opioids won’t change.
Finally, the broad expertise of prehospital care experts needs to be recognized and queried by the commission for incorporation in the final report to the president. EMS leaders and practitioners are encouraged to submit written comments to the commission about the important role of EMS and the need for recommendations to support EMS.
