White House Announces Proposal to Raise Cap on Buprenorphine Prescribing

Today, President Obama is announcing a host of public and private sector initiatives addressing the nation’s opioid epidemic, including a proposal to increase the current patient limit for qualified physicians who prescribe buprenorphine to treat opioid use disorders from 100 to 200 patients.

Additionally, more than 60 medical schools are announcing that, beginning in fall 2016, they will require their students to take some form of prescriber education, in line with the newly released Centers for Disease Control and Prevention Guideline for Prescribing Opioids for Chronic Pain, to graduate.

The proposals met with preliminary approval from APA leaders. “These are very important steps to improve the accessibility of buprenorphine,” Frances Levin, M.D. (pictured above), chair of the APA Council on Addiction Psychiatry, told Psychiatric News. “The problem, however, is getting physicians more comfortable prescribing [buprenorphine], since there are already many physicians who are certified but don’t prescribe or underprescribe.

“Training physicians while they are residents is a very good strategy,” she said. “We need a grassroots approach.”

Her comments were echoed by John Renner, M.D., vice chair of the council. “Our survey of addiction clinicians indicates that the majority are not comfortable treating numbers of patients in [the 150-200 patient] range,” he told Psychiatric News. “It is possible that this change will create a number of large buprenorphine practices, but it will not generate the numbers needed to impact the current epidemic. We remain committed to our proposal to expand treatment services by also encouraging a larger number of small buprenorphine practices by expanding clinician training, permitting prescribing by physician assistants and nurse practitioners, and addressing clinicians’ concerns about the system of DEA inspections.”

The president’s remarks were made at the National Rx Drug and Heroin Abuse Summit in Atlanta. Also speaking at the summit was psychiatrist Patrice Harris, M.D., who is chair of the American Medical Association's Task Force to Reduce Opioid Abuse. As part of her remarks, she encouraged physicians to use state Prescription Drug Monitoring Programs.

“We urge physicians to register and use the state prescription drug monitoring program to check a patient's prescription history; educate yourself on managing pain and promoting safe, responsible opioid prescribing; support overdose prevention measures, such as increased access to naloxone; reduce the stigma of substance use disorders and enhance access to treatment; and ensure patients in pain aren't stigmatized and can receive comprehensive treatment.”

For more information, see the Psychiatric News article “Why Aren’t More Physicians Prescribing Buprenorphine?”

APA Fights for Mental Health Parity as ACA Marks Fifth Anniversary

On the fifth anniversary of the signing of the Affordable Care Act (ACA), APA continues working to ensure that the promise of the reform law—which mandates mental health and substance use service as an essential health benefit and compliance with the federal parity law in newly formed health exchanges—is realized.

In a statement released today, five years after he signed the watershed legislation into law, President Obama said the ACA is working.

“After five years of the Affordable Care Act, more than 16 million uninsured Americans have gained the security of health insurance—an achievement that has cut the ranks of the uninsured by nearly one third,” Obama said. “These aren’t just numbers. Because of this law, there are parents who can finally afford to take their kids to the doctor. There are families who no longer risk losing their home or savings just because someone gets sick. ... There are Americans who, without this law, would not be alive today.”

But the ACA faces a potentially fateful Supreme Court challenge to certain provisions of the law. And a recent study in Psychiatric Services found inconsistencies with the federal parity law in the benefits summaries for mental health and substance abuse services of health plans in two state-run health exchanges. Those inconsistencies—in quantifiable treatment limits (cost-sharing, deductibles, treatment limits) and nonquantifiable treatment limits (prior authorization and other strategies for restricting treatment use)—may either reflect actual no-compliance with the law or an effort by plans to dissuade potential consumers who expect to use mental health services from enrolling in a plan.

APA is pursuing a multifaceted strategy of education and advocacy, as well as legal action against companies that fail to comply with the law. As part of that strategy, APA created the Mental Health Parity Poster and is encouraging psychiatrists and other mental health clinicians to post it in waiting rooms or clinics to educate patients about their legal right to equal treatment. More than 100,000 posters have been distributed, with district branches (DBs) and other associations and hospitals cobranding them. A Spanish-language version is being developed.

For more information, see the Psychiatric Services study "A Tale of Two States: Do Consumers See Mental Health Insurance Parity When Shopping on State Exchanges?“ See also the "Employer Guide for Compliance With the Mental Health Parity and Addiction Equity Act," developed by the American Psychiatric Foundation and its Partnership for Workplace Mental Health.

Obama Proclaims May as National Mental Health Awareness Month

In a proclamation issued yesterday, President Obama has designated May as National Mental Health Awareness Month. In explaining the importance of focusing on mental health and mental illness, Obama emphasized that, "Despite great strides in our understanding of mental illness and vast improvements in the dialogue surrounding it, too many still suffer in silence." He said this special month is an opportunity to "reaffirm our commitment to building our understanding of mental illness, increasing access to treatment, and ensuring those who are struggling know that they are not alone." He stressed the increased access to mental health care that will follow passage of the Affordable Care Act, as well as special initiatives his administration has fostered to address the mental health needs of children and veterans.

In responding to the President's proclamation, APA CEO and Medical Director Saul Levin, M.D., M.P.A., said, “APA applauds President Obama’s proclamation of May as National Mental Health Awareness Month, especially his focus on the need to increase awareness of mental illnesses and make mental health treatment, including for substance use disorders, more accessible to the millions who suffer in silence. In emphasizing that mental illness should not be viewed differently from other illnesses, he is taking a step toward reducing the stigma that too often deters people from seeking help.”

Read the full text of the proclamation here.

Obama Proposes Major Brain Research Initiative

The Obama administration is proposing a major new scientific effort to understand the human brain and map its activity in a way similar to what the Human Genome Project did for genetics.

The New York Times today reported that the project, which the administration has been looking to unveil as early as March, will “include federal agencies, private foundations. and teams of neuroscientists and nanoscientists in a concerted effort to advance the knowledge of the brain’s billions of neurons and gain greater insights into perception, actions and, ultimately, consciousness.” The project could help unravel the mysteries of Alzheimer’s disease and Parkinson’s, as well as find new therapies for a variety of mental illnesses. It is expected to be part of the president’s budget proposal next month, and the Times quoted scientists and representatives of research institutions who said they had participated in planning for what is being called the Brain Activity Map project.

The details are not final, and it is unclear how much federal money would be proposed or approved for the project in a time of fiscal constraint or how far the research would be able to get without significant federal financing.

The Times article is posted here. For information on brain research and its relationship to understanding mental illness and substance abuse see Psychiatric News here.

(Image:Nata-lia/shutterstock.com)

President to Sign Order Enhancing Mental Health Services for Vets

President Obama is expected to sign an executive order today directing the Department of Veterans Affairs (VA) to expand mental health services and suicide prevention efforts. According to a statement released today by the White House, the order will direct the VA to increase its veterans crisis line capacity by 50 percent by the end of the year and ensure that any veteran who says they are in crisis connects with a mental health professional or trained mental health worker within 24 hours. Under the order, the VA will work with the Department of Defense to develop and implement a national 12-month suicide prevention campaign focused on connecting veterans to mental health services. Among other things, the order also calls on the VA to enhance access to mental health care by building partnerships between VA and community providers.

In April the VA announced its intention to hire 1,600 new psychiatrists and mental health professionals. And in comments submitted to the Senate Committee on Veterans’ Affairs that month, APA urged the VA to bolster its efforts to recruit and retain psychiatrists. For more information on APA's comments, see Psychiatric News, here.

(Image: Straight 8 Photography/shutterstock.com)

President Obama Speaks Out On Mental Health Issues of Troops

President Obama focused extensively on the mental health issues and needs of American veterans in his speech yesterday at the American Legion's annual convention. "We’re giving unprecedented support to our wounded warriors, especially those with traumatic brain injury," he told the audience.
 

The president brought up the issues of posttraumatic stress disorder (PTSD) and suicide in veterans, saying: "We’re working aggressively to address another signature wound of this war, which has led too many fine troops and veterans to take their own lives, and that’s posttraumatic stress disorder. We’re continuing to make major investments: improving outreach and suicide prevention, hiring and training more mental health counselors, and treating more veterans than ever before."

He called for an end to the stigmatization of PTSD and depression, pointing to his decision to start sending condolence letters to the families of service members who kill themselves while deployed in a combat zone: "These Americans did not die because they were weak. They were warriors. They deserve our respect. Every man and woman in uniform, every veteran, needs to know that your nation will be there to help you stay strong. It’s the right thing to do."

For more about suicide among combat troops and Obama's decision to send condolence letters to their families, see Psychiatric News at http://pn.psychiatryonline.org/content/46/15/13.full.

(Image: American Legion/Tom Strattman)