Opioid Bill Heads to President Trump’s Desk

The AAA is pleased to report that language we supported on grant funding for opioid protection training for first responders has passed both the House of Representatives and the Senate and is now headed to the President’s desk.

On Wednesday, the Senate passed the Opioid Crisis Response Act with a bipartisan vote of 98-1 in the last necessary needed action before being signed into law by the President. The impact of this legislation on the ambulance industry includes providing resources and training so that first responders and other key community sectors, including emergency medical services agencies, can appropriately protect themselves from exposure to drugs such as fentanyl, carfentanil and other dangerous licit and illicit drugs. $36,000,000 will be given annually for each fiscal year from 2019 through 2023. The bill also gives $10,000,000 in supplemental competitive grants to areas that have a record of high seizure of fentanyl to be used toward training of law enforcement and other first responders on how best to handle fentanyl as well as to purchase protective equipment, including overdose reversal drugs.

Lastly, the legislation allows the Department of Labor to award grants to states that have been heavily impacted by the opioid crisis in order to assist local workforce boards and local partnerships in closing the gaps in the workforce for mental health care and substance use disorder. Based on an analysis by counsel, we believe all ambulance service agencies would be eligible to apply for the described grants. It is encouraging to see both parties and chambers come together to pass legislation that takes steps to better our country as a whole and finally help address this growing public health emergency. The President is expected to sign the legislation into law.

Update on Opioid Legislation & Rural EMS Grant Program

The AAA continues to push on policy issues important to our members we are happy to provide an update on two pieces of legislation that we have been actively monitoring. Congress is proceeding with consideration of several legislative vehicles as they address key topics prior to the November elections.

First Responder Opioid Grant Program

The AAA is pleased to report that language we supported on grant funding for opioid protection training for first responders has passed the Senate. Based on an analysis by counsel, we believe all ambulance service agencies would be eligible to apply for the grants.

In 2017, the Administration officially labeled the Opioid Crisis as a public health emergency, and in response Congress has finally taken action. On Monday, the Senate overwhelmingly passed the Opioid Crisis Response Act with a bipartisan vote of 99-1. The impact of this legislation on the ambulance industry includes providing resources and training so that first responders and other key community sectors, including emergency medical services agencies, can appropriately protect themselves from exposure to drugs such as fentanyl, carfentanil and other dangerous licit and illicit drugs. $36,000,000 will be given annually for each fiscal year from 2019 through 2023. The bill also gives $10,000,000 in supplemental competitive grants to areas that have a record of high seizure of fentanyl to be used toward training of law enforcement and other first responders on how best to handle fentanyl as well as to purchase protective equipment, including overdose reversal drugs.

Lastly, the legislation allows the Department of Labor to award grants to states that have been heavily impacted by the opioid crisis in order to assist local workforce boards and local partnerships in closing the gaps in the workforce for mental health care and substance use disorder. Counsel has provided us with an analysis that all types of ambulance service organizations would be eligible for the described grants. While this legislation is not a solution to every aspect of the opioid crisis our country is currently experiencing, it is an important first step in providing resources to the ambulance industry and others to help combat this public health emergency.

Rural EMS Grant Program

The AAA is diligently working on amending the SIREN Act (S. 2830H.R. 5429) which would reauthorize the Rural EMS Grant program. In an effort to ensure the funding would go to the most needy, small, and rural EMS providers, the language of the SIREN Act would change the eligibility to just governmental and non-profit EMS agencies. Therefore, small rural for-profit ambulance service providers would no longer be eligible to apply for grants. The AAA will continue to work to ensure that all provider types will be able to apply for these grants.

Language similar to the SIREN Act has been included in the Farm Bill (S. 3042/ H.R. 2) that passed both the House and Senate. The Farm Bill is now in Conference Committee between the House and Senate to reconcile differences before final passage. Over the past weeks, the AAA has been pressing Senator Durbin as well as other co-sponsors and Farm Bill conferees to revise the language to ensure small rural for-profit providers would still be able to apply for grants. Our team has met with all co-sponsors of the House and Senate SIREN Act Bills as well as members of the Farm Bill Conference Committee to ensure that they are well informed of the impact this legislation will have on their local providers.

The AAA team has also been conducting targeted outreach to AAA members asking them to get involved by contacting their Members of Congress, especially those on the Conference Committee. It is important for Congress to hear that grants like this one, should be open to all provider types. We thank those members who have already sent letters to their representatives. With Congress trying to wrap up the Farm Bill by the end of September – although looking unlikley, the AAA is pushing hard to change the current language and make sure that all providers might have access to these grants once they are reauthorized.

The AAA will continue to keep you updated on any new developments.

Battling the Opioid Crisis as Employers

As ambulance providers we are acutely aware of the opioid crisis in the United States. As providers of emergency medical care, our EMS agencies have been responding to, and providing life–saving treatment to opioid users. In addition to fighting this crisis in the field, we can also combat opioid use in another way. The Society for Human Resources Management (SHRM) published an article this week, Surgeon General Calls On Employers to Combat Opioid Epidemic, regarding the role that employers can take in helping to fight the opioid epidemic. 

The U.S. Surgeon General is urging employers to utilize the information available to them from employer sponsored health plans to restrict access to certain medications associated with the opioid crisis. In addition, he urged employers to utilize employer sponsored health plan claims data to gain insight to the de–identified beneficiary use of opioid medications. Employers with self–funded or captive insurance plans have greater access to claims information and can focus efforts more meaningfully. Lastly, the Surgeon General encouraged employers to ensure that employees have access to mental health and addiction medicine treatment benefits and suggested health plans that utilize Pharmacy Benefits Management (PBM) to limit opioid prescriptions in an effort to better align with the Centers for Disease Control and Prevention’s (CDC) Guideline for Prescribing Opioids for Chronic Pain.

Keep in mind, opioid addition impacts not only our patients but our employees and their families. This crisis will only begin to improve when we utilize all available information and tools that reduce opioid use and abuse. For more suggestion on what steps your organization can take to step up your efforts, contact the American Ambulance Association.

Is Narcan the Answer?

There has been a lot of talk recently in social media and the news about leaving Narcan behind after a reversal of an opioid overdose. A new voluntary program in Pittsburgh, PA allows the state to pay for Narcan atomizers that EMS can leave with friends and family of OD patients. The media buzz revolves around the idea that we are enabling this cycle of addiction; “There is some pushback that maybe you’re enabling the problem a little bit, but at least in the short term, reduce the chances that person is going to die and you create more opportunities to get them into treatment,” said Mark Pinchalk, patient care coordinator for Pittsburgh EMS.” (Media, 2018, para. 3) I agree with Mr. Pinchalk that as an EMS Provider we are not there to judge, we are there to render aid.

One of my early instructors said, “Scott, your purpose is to leave the patient better than the way you found them.” I have taken that long ago statement to heart ever since, trying to leave the patient better than the way I found them whether that is medically as in a Diabetic whose blood glucose I raise from 20mg/dl to 130mg/dl or the person who receives a ride to the hospital to be  checked out. EMS is about providing care. When we use our own judgements or opinions on our patients, it impedes or influences the care we provide.

These particular cases seem to bring out strong opinions surrounding a delicate issue. Thousands of people die every year from Opioid overdoses. A healthy percentage of them get their start on prescription pain killers. So where do we help? How do we not judge going to the same address three or four times a week to treat the same person in the same situation? These are just some of the tough questions providers and services face every day in America. Although we are trying to hold back the tide with a broom, it is up to us to provide the same level of care each and every time, regardless of the person or situation.

Will leaving Narcan at the scene save lives? Yes, I believe so. Will it encourage more drug use? I can’t be sure. Time will tell.

In comparison, studies show making birth control available to teens actually reduces sexual activity and reported pregnancies. Consider 2017 data that shows “Among adolescent females aged 15 to 19, 42 percent report having sex at least once. For males, that number was 44 percent. The numbers have gradually dropped since 1988, when 51 percent of female and 60 percent of male teens reported having had sex.” (Welch, 2017, para. 4)

So for now, I encourage the opportunity, as the law allows, to provide Narcan, knowing it doesn’t make the problem go away. And I look forward to EMS impacting this youthful epidemic. How? Community Paramedicine are the resource to embrace. Just like any other frequent patient, community paramedics will help those get the services they need including the much-needed follow up care.


Scott F. McConnell is Vice President of EMS Education for OnCourse Learning and one of the Founders of Distance CME, which recently launched a new learning platform. Since its inception in 2010, more than 10,000 learners worldwide have relied on Distance CME to recertify their credentials. Scott is a true believer in sharing not only his perspectives and experiences but also those of other providers in educational settings.

References

Media, C. (Ed.). (2018, Jan, 26th, 2018). Local EMS starts program to leave Naloxone with OD victims. WPXI.com. Retrieved from http://www.wpxi.com/news/top-stories/local-ems-starts-program-to-leave-naloxone-with-od-victims/689842523

Welch, A. (2017, June 22nd, 2017). Are today’s teens more responsible about sex? CBS News. Retrieved from https://www.cbsnews.com/news/teen-sex-trends-birth-control-cdc-report/

Fentanyl Increasingly Dangerous to First Responders

Fentanyl is a powerful drug that can be 50 times more potent than heroin. First responders are being warned to take precautions to avoid being exposed to the drug. Photo courtesy of the Drug Enforcement Administration.

The explosion of the opioid epidemic that is responsible for thousands of overdoses and deaths is a consistent problem that EMS and law enforcement encounter on an almost daily basis. Usually, the victims of these powerful drugs, such as heroin and fentanyl, are opioid users, who EMS personnel and law enforcement are regularly called to assist. However, first responders are also being warned about the increased risks they face of being exposed to these deadly drugs, specifically fentanyl—a popular synthetic opioid that is 40 to 50 times more powerful than heroin. To respond to these dangers, the Drug Enforcement Administration (DEA) released a field guide called “Fentanyl: A Brief Guide for First Responders” for EMS and police who find themselves responding to opioid-related calls.

“We need everybody in the United States to understand how dangerous this is,” Acting DEA Administrator Chuck Rosenberg warned. “Exposure to an amount equivalent to a few grains of sand can kill you.”

The warnings have become more urgent in recent months due to numerous cases of accidental overdoses and exposures involving EMS and police.

In May, Chris Green, a police officer with the East Liverpool Police Department, was accidentally exposed to fentanyl during a routine traffic stop after he inadvertently ingested the drug through his skin. Green needed four shots of Narcan, an emergency overdose medication, to be revived after collapsing from the effects of the drug. In another case, two Paramedics and a sheriff’s deputy in Hardford County, Maryland, were treated after showing signs of opioid exposure while treating an overdose victim.

“It is important to get the word out to everyone because it may be the first responder who needs to have Narcan administered,” said Baltimore City Health Commissioner Leana Wen.

The risks of accidental exposure are so high, in fact, that some emergency personnel have even begun carrying Narcan kits for drug-sniffing K-9s, just in case the dogs ingest the deadly drugs.

The DEA guide, along with a National Institute for Occupational Safety and Health manual on preventing fentanyl exposure, suggests certain precautions be taken to lower the risk of coming in direct contact with the substance. Personnel should be able to recognize the signs and symptoms of an overdose, be aware of the ways fentanyl can be ingested, and only allow trained professionals to handle substances that are suspect.

“Assume the worst,” Rosenberg said. “Don’t touch this stuff or the wrappings that it comes in without the proper personal protective equipment.”

The DEA video “Fentanyl: A Real Threat to Law Enforcement” offers advice on how police and EMS can protect themselves from the dangers of fentanyl.

Read more about fentanyl.

 

NHTSA and NASEMSO Host Panel on EMS Practices

The National Association of State EMS Officials (NASEMSO) and the National Highway Transportation Safety Administration (NHTSA) hosted a series of meetings for subject matter experts to discuss revisions to the National EMS Scope of Practice model. The experts reviewed the model’s practices, examined education and training procedures, and discussed what certification level, if any, is needed for specific treatments that are now widely-used among EMS professionals. The panel focused on five specific procedures that are commonly practiced: hemorrhage control, Naloxone use, CPAP use, therapeutic hypothermia in cardiac arrest, and pharmacological pain management.

Over the next several months, the panel will continue to examine information and recommend changes to the Scope of Practice model, with final recommendations tentatively set to be submitted in August 2018. For more information, please visit NASEMSO’s website.

 

 

HHS to Administer $70 million in Funds to Combat Opioid Crisis

The Department of Health and Human Services (HHS) announced $70 million in grants to help communities and health care professionals combat the ongoing opioid crisis that is ravaging communities across the U.S. The majority of the money will be used to help prevent opioid-induced deaths and to provide treatment for people with opioid use disorders, including $28 million allotted for medication-based treatment. More than 33,000 lives were claimed in 2015 due to opioid overdoses.

$41.7 million of the funding is set to expand resources and training for first responders on how to use emergency treatments, such as Narcan, to help reverse and treat overdoses. In many cases, first responders are often the difference between life and death for opioid users who experience an overdose, so it is imperative health care professionals have access to the needed resources and training to help save lives. The additional funding aims to help paramedics, EMTs and other emergency service personnel gain access to much-needed resources.

“The grants we announce today clearly demonstrate our efforts to meet the opioid crisis with every tool at our disposal,” said Substance Abuse and Mental Health Services Administration Acting Deputy Assistant Secretary Kana Enomoto. “The evidence-based training, medication, and behavioral therapies provided here will save lives and help people with addictions start a path toward reaching their potential.”

In addition to the most recent grants, $485 million in grants were awarded in April to treat and prevent opioid abuse.

To read more about the grants, please visit the HHS web site.

Savvik: Beat the EpiPen (Epinephrine) Price Surge!

Savvik Buying GroupYou may have seen in the American Ambulance Association’s Digest newsletter that many ambulance services are facing a 400% price increase in the price of  EpiPen epinephrine injections. AAA members are beating the surge through AAA’s partnership with the Savvik Buying Group (formerly the North Central EMS Cooperative). Members, save big on Epi-Pen and Epi-Pen Jr today!

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Epinephrine Auto-Inject Jr

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AAA Meets with FDA on New Drug Dispenser Regulations

On October 21, the AAA participated in a meeting with stakeholders and the Food and Drug Administration (FDA) about the need to ensure new regulations don’t discourage the transfer of small quantities of drugs between dispensers, hospitals and first responders among others. Under the Drug Supply Chain Security Act of 2013, starting on November 1, drug dispensers must provide a full transaction history for transactions involving even small transfers of drugs. Since these transactions are often done in paper form, it will be difficult for many drug dispensers to be compliant with the new regulation and may opt to not distribute drugs in small quantities.

The AAA is participating in a coalition to ease initial enforcement on small transactions to help ensure those hospital pharmacies that provide first responders with drugs under a safe harbor agreement or direct cost reimbursement will continue to do so. The coalition of stakeholders including the AAA had sent a letter to the FDA on September 24 requesting the meeting.