SUPPORT for Patients and Communities Act

SUPPORT for Patients and Communities Act

President Donald Trump signed the bi-partisan opioid legislation on October 24.

According to Vox, the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act “is a big breakthrough that will boost access to addiction treatment and many other interventions to mitigate the opioid epidemic.”

Vox is correct in saying that the legislation may help provide access for treatment of opioid addictions. However, the legislation is only a small step in the right direction rather than a lasting solution to the twin crises of pain and addiction.

The Vox article points out that the legislation, in part, seeks to decrease the over-prescription of opioids. That’s the approach the CDC used when it published its Guideline for Prescribing Opioids for Chronic Pain, and — because of its misapplication — the guideline has caused more harm than good.

New Opioid Legislation Faces Challenges

The Support for Patients and Communities Act may face similar challenges. Its potential effectiveness will depend on how it is implemented. I think it is premature to dance in the street over the legislation when we experienced a record number of 72,000 drug-related deaths last year, despite our efforts to reduce overprescribing.

The best part of the legislation, from my perspective, is the increased funding it provides for research to find analgesics that are effective and not addictive.

Reducing the number of prescription opioids without a safer alternative will only contribute to more illegal drug use and/or increased suffering by people in pain. Increased funding for addiction treatment is a good thing, but it will not eliminate the disease.

We need to prevent the disease of addiction from occurring by reducing the demand. To do that, we must understand the actual roots of the opioid crisis. Social and economic determinants lead to substance use disorders, and those must be addressed.

Additionally, we must reduce the stigma and increase access to treatment by decriminalizing substance use disorders. Physicians need to have the tools and freedom to help patients with pain and addiction without fearing legal jeopardy.

Omissions in New Legislation

The legislation was well-intentioned, but there are some obvious omissions.

First, it failed to mandate that payers provide coverage for substance use disorders without the need for preauthorization. Delays in treatment due to the need for preauthorization or step therapy often ends in tragedy. The Trump administration should have mandated coverage for everyone with addiction who is ready for treatment.

Second, the legislation should have mandated that insurers cover abuse deterrent formulations (ADFs). In May of 2017, the Institute for Clinical and Economic Review (ICER) concluded, “ADFs have the potential to substantially reduce the incidence of opioid abuse relative to non-ADF formulations among patients initially prescribed these drugs.” Therefore, the legislation should have required payers to make abuse deterrent formulations tier one coverage and no more expensive than generics.

Third, the legislation should have forced medical schools to require a minimum number of educational hours on pain and addiction. Chronic pain and substance abuse are the two most common public health problems we face. Both have been, and continue to be, inadequately addressed in medical schools and post graduate education programs.

Trump Administration Needs to Understand

The administration should understand we have a drug crisis, not just an opioid crisis.

Addiction is a medical disease that will not be solved with legislation or punitive laws.

Most of the action to date by the administration has failed to help solve the drug crisis, but it has made life unbearable for many people in pain.

My hope is that the administration understands we need to have compassion for people with addiction and pain, but that we must allow the science to inform policy.

For my additional thoughts about — and the reactions of other experts to — the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act, please read CNN’s article by Wayne Drash, “Trump claims on opioid crisis met with mix of skepticism and hope by experts as deaths plateau.”

Photo credit: Shutterstock




  1. Marsha Stanton on October 27, 2018 at 11:23 pm

    Thank you for clarifying many of the points in this act. We all agree it’s a start, but sadly a small step in what needs to be a large and complex undertaking. I suppose for now we should be glad we seem to have begun to have a few more people understand the breadth and complicated nature of the patient plight for those with pain

  2. Jacqueline on October 28, 2018 at 3:01 am

    There are so many layers to this, not to mention barriers. I am a chronic pain patient going on six years. I have been on the same anti abuse ER med for more than five years. Recently, my husband’s employer changed to another insurer and pharmacy plan. In the past when this occured, the pharmacy provider would pay for any refills of whatever meds you where on for the first fill, then notify you if prior auth was needed. This new provider will not. They don’t cover the med I need. They feel it’s no problem just changing to a different controlled substance. There are seven on the list of preferred, and they said I have to try and fail every one before the one I need will be considered. Wow, that would look great seeing that on the PDMP list? Also transitioning is supposed to take place slowly with close monitoring! Phhhhht! Like that would really happen! We all know the opioid conversion tables are just crude estimates. I could cash pay and avoid jumping through all the hoops and aggrevation if I don’t mind paying over $2000 every month.

    I was given incorrect info from the rx provider. First they said my pcp just had to submit a prior auth request, then they said no, it has to be a letter of “medical necessity”. I made the first request to my pcp to do this tuesday. When I called the rx provider thursday, they stated nothing was submitted yet from my pcp. That’s when they changed from prior auth to letter of medical necessity. I requested to speak with a supervisor to determine which was correct. I called my pcp to pass this info on. They said they already phoned in the prior auth by phone the day before. The rx provider said they didn’t. I asked my pcp’s office to please contact the rx provider supervisor directly so whatever needed done would be correct going forward. I asked pcp’s staff to make an urgent request, and was told it would be done asap. A few hours later, I phoned the superviser of rx plan to see if my pcp’s office had finally submitted what rx provider requested. She stated she didn’t know because it was pizza lunch day, and she was the one taking care of that!!! She stated she would reach out to my pcp’s office.

    My two meds are due to be refilled 11/3. No one is concerned that I have been on a controlled ER substance for almost six years, I am dependent, and there is a realistic possibility I may have severe withdrawl without it, not to mention the severe pain I will be suffering from. The pharmacy will not keep my med in stock. They will only order it when I present the written scripts! I am disabled and can’t drive so someone has to pick up written scripts at the pcp office for me. As of this moment, I have no idea if my pcp has submitted the correct info, If they did, I have no idea if the supervisor received it or began processing it because pizza day may have been her priority. The only way I won’t get screwed by 11/3 is if the planets align or God himself comes from heaven and takes care of the situation himself! If prior auth is denied, I have to wait for pcp to decide what preferred med he will transition me to, and the dosage. I am allergic to morphine, any nsaid, and had a reaction to oxymorphone. Then he has to void out the two scripts for my meds he already prepared a week ago. Once that’s done, I have to wait until someone on the staff finds the time to call me to let me know new scripts are ready to be picked up. Most assured my pharmacy will not have the med in stock so I will have to wait days before I will have the meds.

    Bottom line, no one cares if I am put in this potentially catostropic situation. The rx provider is more concerned with saving money, than safe practices. They don’t care that I will NOT be transitioned slowly to another “controlled substance” while NOT being monitered closely. They don’t care that there is no conversion estimate for my current ER med, or that the dosage chosen for a preferred may not be correct or that my current med is safer than the other seven on the list. They don’t care that I had a reaction to a med in the past that caused me to have hives 24/7 for five months, or that another med caused acute angioedema on four different occasions that required ER visits due to my face being so swollen my eyes were slits, had chest pains and tightening of my throat and bags of fluid under my eyes.

    But….those poor addicted people who are victims! Someone caused them to become addicted and abuse drugs. They are not at fault in any way. They didn’t have a choice and we should not hold them accountable for their choices. They have a disease! They may overdose any moment or get a drug that may kill them! So here is free Narcan. They could suffer withdrawls too if they can’t get access to their drug! Their poor families have to watch them suffer and are helpless to help them. We need to throw every available resource into helping these people. Spare no expense. If they have no insurance, no problem. There must be no obstacles that delay or interrupt their treatment and there needs to be a process that streamlines the care they deserve as human beings. Huge amounts of documentation and phone calls will slow this process down and that is unacceptable! There should never be a “list” or database to keep track of addicts habits or if they overdose because we don’t want to label them or attach a stigma to them even though drug abuse is a crime. (yes I am being sarcastic)

    Does anybody see a problem with this situation at all?


    My personal physician is the ONLY person who has detailed knowledge of my health history, pathologies, and chronic, intractable pain. He is the only person who should be making any decision about my medical care and treatment. He is the only one who has a license to practice medicine!

  3. Susan Stephenson on October 28, 2018 at 6:28 am

    This Act is only another nail in the coffin from the Feds to all patients in pain: Acute, post op, intractable CPP’s. Clearly, there continues to be the implication that millions and millions of ppl in any kind of pain are either non existent OR only deserve to suffer.

    Im glad the illicit addicts responsible for the National Pain Crisis will no longer have excuses to not undergo treatment for their illicit addictions, multi use disorder since there are billions of $ on the table POTUS has signed into law. Im sure this will comfort the rising numbers of families/survivors who are losing their loved ones to suicide from pain too great to bear. Suicide for the intractable CPP is the only pathway remaining for any hope and assurance of relief. Pain clinicians are witch hunted and charged now even in palliative care and hospice facilities. Guilty of doing their jobs…

  4. David W Cole on October 28, 2018 at 2:51 pm

    Thank you Dr Webster, as always you hit the nail on the head. As someone who’s looked for a over a decade for alternative treatments for peripheral neuropathy, not because I don’t get relief from opioid pain medication, but because I don’t want to be dependent on a doctor to take care of my pain. Sometimes I wonder if some people really want to find alternative treatments that work. For instance you can make painkillers out of bed weed that grows everywhere, there’s also DMSO mixed with the right ingredients, and people taking great care and proper use of it. I found since my opioid pain medication has been cut by 2/3 there are natural things that help. I just hope I don’t make a mistake and up dead or in the hospital trying to make concoctions that help with the pain. They definitely need to work on how they treat people who are addicted, my first pain doctor about 14 years ago was an addiction specialist / pain specialist, after his sidekick about killed me with methadone, I had to find another doctor. But why was at his Clinic I seen how the addicted were treated, starting at the front desk they were treated like the plague, people coming in for some kind of shots in their back we’re greeted with a smile and ushered off to the back and treated like gods. I don’t know about now but back then addiction clinics had about 10-20% success rate, at least those who were remanded by court order.

  5. Larry Wilson on October 29, 2018 at 6:10 pm

    Help me understand this please How does this affect all of us? I have been trying to follow all this opioid freak out since the rescheduling by Obama in 2014 and I am just completely bewildered, once again. I am not here to whine and moan I only want to understand. But please understand this, about me. I am 62 now and my dependence on pain meds began at age 16 when a lariat rope encircled my neck while riding a motorcycle at 40 miles per hour and virtually hung me. The scar is still there. They could not do anything in 1972 to help me physically but they could “give me these pills.” I did not know any better I was 16 years old and all I wanted was for the pain to stop.Twenty plus accidents have occurred since then. The last three were on the job in the last year and a half with another neck injury and upper thoracic and then a leg injury when a mother cow pounced upon my leg. With having to be on crutches all that winter and since my neck and thoracic injury did not have tiome to heal I am disabled entirely. But since this was a farm job and my employer I had at the time is exempt from work comp I have to pay for any medical bills. Trying to file for disability is an ongoing fight. My heart is going now because of the extra stress on my body, but yet we have to stop the drugs for everyone a bunch of fienders are killing themselves on fetanyl and heroin? God help us where is the logic in all this? This is the knee jerk reaction one would expect from liberals! Which Trump is not a liberal knee jerking illogical ,president,except on “the opiod crisis. So many questions with never a good answer I just want to give up I am so tired of fighting and never knowing if I am going to be forced into death by withdrawals or death by my own hand. How? HOW could something that was meant to be for primary care physicians ONLY as CDC’s Debra Houry stated herself get so blown out of proportion into such a bewildering and baffling bunch of b-s???

  6. Andrea Lee Stacy on November 13, 2018 at 2:59 pm

    I am at the time of this writing a severe/chronic pain pt. Unfortunately I must take some responsibility for not getting the seven surgeries I need as I am a criminal x2! Not only am I dependent on high doses of meds for brief, mild relief-however in addition to that stigma I have been unable to quit my cigarette habit. I am quite clearly worse than a serial killer. I receive my “filthy cigarettes” for free so I am not poor due to smoking. I would LOVE to stop; however the ruder and more dismissive the Dr.’s become when they see my ‘painkiller’ list but when they find I have not been able to quit puffing my smokes I am dismissed as a heap of detritus they have no clue ended up in their office. The increasing pain, anxiety, fear, isolation, and immobility only increase my smoking habit more.. Of course I am aware of my rationalizing but not anything Becoming too pained to continue. Sorry-skipped all the politics I wanted to delve into. Really hurts at the moment. Thank You I’ve tried has helped make a dent in my cravings I fear ending all the misery but I do have God in there scaring me re: taking my own life therefore it is not an option….Well; have yet to see any political changes that give us much hope. All the politicians in N.Y, are on the same bandwagon. Sorry this became scattered; illogical-transposed sentences going back to fix a typo.

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