President Trump should declare a “national emergency” to combatthe nation’s opioid epidemic, according to a draft interim report issued Monday by the President’sCommission on Combating Drug Addiction and the OpioidCrisis.

“With approximately 142 Americans dying every day, America isenduring a death toll equal to September 11^th everythree weeks,” the commission writes. The group adds a declarationfrom Trump “would empower your cabinet to take bold steps and wouldforce Congress to focus on funding and empowering the ExecutiveBranch even further to deal with this loss of life. It would alsoawaken every American to this simple fact: if this scourge has notfound you or your family yet, without bold action by everyone, itsoon will.”

The commission, created by a March executive order and chairedby New Jersey Gov. Chris Christie, provides additionalrecommendations after the group conducted public hearings and metwith representatives from the medical community, advocacy groups,governors’ offices, members of Congress, and key cabinet members ofthe Trump administration.

The commission proposes that the administration grant waiverapprovals for all 50 states to quickly eliminate barriers totreatment resulting from the federal Institutes for Mental Diseasesexclusion within the Medicaid program, which would “immediatelyopen treatment to thousands of Americans in existing facilities inall 50 states.”

“The Commission has been urged by every Governor, numeroustreatment providers, parents, and non-profit advocacy organizationsto eliminate the IMD exclusion within the Medicaid program,” thecommission writes. “This component of the Social Security Actprohibits federal Medicaid funds from reimbursing services providedin an inpatient facility treating ‘mental diseases’ (includingSUDs) that have more than 16 beds. This exclusion makes statesentirely responsible for Medicaid-eligible patients in inpatienttreatment facilities, including patients undergoing withdrawalmanagement in addiction treatment facilities rather thanhospitals.”

While the commission concedes that Congress would have toenact legislation to repeal the exclusion in its entirety, thegroup writes that Department of Health and Human Services SecretaryTom Price could immediately grant waivers to each state thatrequests one, particularly after Trump makes an emergencydeclaration.

“This is the single fastest way to increase treatmentavailability across the nation,” the commission writes.

The group also recommends the federal government mandateprescriber education initiatives with the assistance of medical anddental schools across the country to enhance prevention efforts,and mandate medical education training in opioid prescribing andrisks of developing an SUD by amending the Controlled Substance Actto require all Drug Enforcement Administration registrants take acourse in proper treatment of pain. HHS should work with partnersto ensure additional training opportunities, including continuingeducation courses for professionals.

The commission cites a Substance Abuse and Mental HealthServices Administration Center for Behavioral Health and StatisticsQuality report, which found that 4 out of 5 new heroin users beginwith nonmedical use of prescription opioids.

“In other words, Mr. President, this crisis began in ournation’s health care system,” the commission writes. “While weacknowledge that some of this inappropriate overprescribing is doneillegally and for profit, we believe the overwhelming percentage isdue to a lack of education on these issues in our

nation’s medical and dental schools and a dearth of continuingmedical education for practicing clinicians. This can and must besolved by using Presidential moral and legal authority to changethis lack of education leading to addiction and death.”

The commission did cite a number of initiatives around thecountry aimed at ensuring that providers are aware of the potentialfor misuse and abuse of

prescription opioids, including several states’ expansion ofcontinuing medical education requirements for opioid prescribersand dispensers.

“We urge national implementation of these initiatives,” thecommission writes, adding that in the group’s first meeting,several nonprofits discussed the need to promote expandedimplementation of the CDC Guideline for Prescribing Opioids forChronic Pain through increased prescriber educationinitiatives.

The commission also urges Trump to instruct the Department ofJustice and the Drug Enforcement Administration to requirecontinuing medical education for every physician requesting aninitial DEA license or the renewal of such a license.

Moreover, the CDC and the U.S. Food and Drug Administrationshould finalize, review and recommend national training standards,working with the Accreditation Council for Continuing MedicalEducation to ensure training courses are coordinated with otherfederal agencies, professional societies, medical schools andresidency programs to avoid discrepancies.

The FDA should also work with the ACCME to develop dataanalytics to determine whether courses change practices, increasepatient referrals to treatment, and methods to improve complianceconsistent with opioid prescribing education, the group says.

“Clinicians need more detailed and specific guidance on drugchoice, dose, and quantity to be dispensed in treating specific pain conditions,” thecommission writes. “We also recommend a detailed analysis of, andsolutions to, clinical problems encountered in applying recommendedguidelines.”

The commission also recommends that the government immediatelyestablish and fund a federal incentive to enhance access tomedication- assisted treatment, and require that all modes of MATare offered at every licensed MAT facility and that those decisions“are based on what is best for the patient.” The administrationshould also partner with the National Institutes of Health and theindustry to facilitate testing and development of new MATtreatments.

“MAT has proven to reduce overdose deaths, retain persons intreatment, decrease use of heroin, reduce relapse, and preventspread of infectious disease,” the commission writes. “Expansion ofMAT availability for qualified individuals and for short- orlong-term treatment is an essential.”

The commission will issue another report on recommendations inthe fall.