December 4, 2017
The Honorable Bob Casey
United States Senate
Washington, DC 20510
Re: S. 2004, Combating the Opioid Epidemic Act
Dear Senator Casey:
On behalf of the American College of Occupational and Environmental Medicine, thank you for introducing S. 2004, the Combating the Opioid Epidemic Act, which will provide much needed funding to bolster the federal government's response to the opioid epidemic.
Your legislation would invest $45 billion for prevention, detection, surveillance and treatment of opioid-related health problems, including nearly $4.5 billion per fiscal year through 2027 for substance abuse programs in individual states and $50.4 million per fiscal year through 2022 for research on addiction and pain related to substance abuse. We ask that you consider an amendment to the bill.
As introduced, the legislation amends Section 1003(c)(1) of the 21st Century Cures Act, which requires a State receiving a grant under this section to establish a comprehensive response plan to opioid abuse. This Section, as amended by S. 2004, would add additional provisions to be considered by a State when developing a plan.
ACOEM requests that you consider adding a requirement that such a State plan include the performance of periodic and regular functional assessments by health care providers to ensure that they can determine whether opioid use presents a hazard to the patient, co-workers, or the general public when using opioids. Addressing patient functional goals and documentation of functional capabilities at every visit will assure that patients have the best outcomes.
The national dialogue about the use of opioids in medical treatment provides an example of the tension between process and outcomes – with the discussion increasingly focused on the importance of functional outcomes as the best assessment measure for opioid effectiveness. The recent emphasis upon outcome-oriented guidelines and standards for opioid treatment, offered by multiple organizations, is a signal of the importance of creating consistent, agreed-upon, outcome measures to achieve value. If more providers prescribing opioids were focused on similar functional outcomes as their treatment goal, the health system as a whole would be better equipped to reduce opioid abuse.
ACOEM represents more than 4,200 physicians and other health care professionals who specialize in OEM. Founded in 1916, ACOEM is the nation’s largest medical society dedicated to promoting the health of workers through preventive medicine, clinical care, disability management, research, and education. Chronic pain and opioid abuse and misuse are important issues for OEM physicians whose practice often involves treating or managing patients with pain related to workplace injury and illness.
Thank you for your leadership in addressing the opioid epidemic. Please do not hesitate to contact either me or Patrick O’Connor, ACOEM’s Director of Government Affairs, at 703/351-6222, should you have any questions.
Charles M. Yarborough III,MD, MPH, FACOEM