As a nation, we are working incredibly hard to turn the course of the opioid epidemic in a new direction. This week I had the great pleasure to be part of an event that focused on hope, possibilities and action. President Obama announced new initiatives that would expand access to treatment for substance use disorder, among other important actions that align with measures we physicians have recommended.
The president’s initiatives, announced Tuesday at the National Rx Drug and Heroin Abuse Summit in Atlanta, combined with the progress of related legislation in Congress, make it clear that addressing this epidemic is a national priority. The administration has taken the next step to expand access to treatment, prevent overdose deaths and increase community prevention strategies. So how do these actions fall in line with the recommendations of the AMA Task Force to Reduce Opioid Abuse?
The steps that we need to take
We are seeing that physicians have become more judicious in our prescribing practices as the number of prescriptions for opioids has fallen in recent years, according to new data from IMS Health. From 2013 to 2014, the number of opioid prescriptions decreased 2.9 percent nationally. From 2014 to 2015, the number of prescriptions decreased another 6.8 percent, and every state saw a decrease in the number of opioid prescriptions.
This is a good sign, but we need many solutions working together to end the nation’s opioid epidemic.
Reducing the stigma that surrounds substance use disorders and expanding access to treatment are two such essential solutions. The AMA task force has called for these actions, and the initiatives the president announced also aim to achieve these goals. Stigma has no place in medicine or society, yet its prevalence is clear. Patients with pain deserve care and compassion—not judgment.
Several components of the proposal include measures that will help increase treatment for patients with substance use disorders. The Department of Health and Human Services (HHS) is issuing a proposed rule to increase the patient limit for qualified physicians who prescribe buprenorphine to treat opioid use disorders from 100 to 200 patients. This measure aims to increase access to medication-assisted treatment (MAT) combined with behavioral health support for people with opioid use disorders.
We are pleased with the extension of the patient limit, but it should not stop there. Treatment with buprenorphine should not be limited to a certain number of patients if the physician is qualified to deliver this kind of care. The benefits have been proven to enhance recovery, so every patient with opioid use disorder should have access.
HHS has released $94 million to expand MAT training, which will help increase the number of physicians qualified to prescribe buprenorphine in nearly 300 community health centers that treat underserved communities.
Increased patient access to buprenorphine can be further bolstered when physicians take advantage of education to better recognize substance use disorders. We will be better equipped to help our patients on the front lines of this epidemic by doing all we can to help our patients get into treatment, which also includes helping them understand that substance use disorders can be successfully treated. We strongly agree with the president that it is important that we treat opioid use disorder as a disease and not a flaw in the patient who is suffering.
HHS also has finalized a rule to enhance access to mental health and substance use services for Medicaid and CHIP plans by treating these conditions in the same way as medical and surgical benefits. According to the White House, these protections are expected to benefit more than 23 million people within these programs.
Requiring that substance use disorder be treated and paid for in the same way as other medical conditions is a giant step toward reducing stigma. Patients will feel more comfortable seeking treatment, preventing them from hiding their substance use disorders.
Another focus of the task force is to increase access to the lifesaving overdose reversal drug naloxone. As part of the president’s proposal, the Substance Abuse and Mental Health Services Administration is releasing $11 million in funding for states to purchase and distribute naloxone and train first responders in its use. The task force also recommends that physicians co-prescribe naloxone to patients who are at risk of overdose.
Other important solutions the task force has identified include enhanced physician education on managing pain and promoting safe, responsible opioid prescribing and use of state prescription drug monitoring programs (PDMP) to check patients prescription histories.
These are significant signs of progress, but action does not end here
There is a large and growing gap between the number of patients who need treatment for substance use disorders and the availability of MAT. These initiatives will help to close that gap. Additional details about the proposal to address the prescription opioid abuse and heroin epidemic are available on the White House website.
Even as we call on Congress to act, we physicians must continue to do everything in our power to end this tragic epidemic. From making sure we have the latest education on safe prescribing practices and are using our state PDMPs to co-prescribing naloxone and reducing stigma, we each can play an important role. Together, we’ll save the lives of tens of thousands of patients.
