Changes overdue on how substance-use disorders are covered, treated

The AMA is “laser-focused” on removing barriers to treatment for opioid-use disorder (OUD) and this includes eliminating stigma and prior authorization for medication-assisted treatment, AMA President Patrice A. Harris, MD, MA, told attendees at the HLTH conference in Las Vegas.

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Dr. Harris, an Atlanta psychiatrist who chairs the AMA Opioid Task Force, participated in an expert panel discussion on how the health system is tackling the epidemic using “smart tech, powerful local initiatives, rethinking regulations and an unwavering determination.”

The conference is billed as an “ecosystem event for the health industry” that brings together 6,400 leaders from payers, health care organizations, employers, investors, startups, pharma, policymakers and more.

The sessions other panelists included the CEO of one company that makes heavy use of telehealth while treating OUD in a value-based payment model, and the chief executive of another company developing “prescription digital therapeutics” using Food and Drug Administration-approved software to treat serious disease—including OUD.

Dr. Harris told the audience about the AMA task force’s recommendations to:

  • Enhance access to evidence-based treatment for pain and substance-use disorders.
  • Enhance opioid-related education efforts.
  • Monitor enforcement of insurance parity laws for mental health services.
  • Reduce stigma.

More recently, the AMA and Manatt Health released a “National Roadmap on State-Level Efforts to End the Opioid Epidemic,” which identifies state-level best practices and provides recommendations to increase access to evidence-based care for pain and opioid-use disorder as well as improve harm reduction efforts. The national roadmap was based, in part, on prior AMA-Manatt analysis of efforts in Colorado, Mississippi, North Carolina, and Pennsylvania.

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AMA resources lead to action

Panelist Kody H. Kinsley, deputy secretary for behavioral health for the North Carolina Department of Health & Human Services, gave the AMA credit for providing states with useful resources.

“North Carolina has an action plan—it cribs a lot from your plan, thank you,” Kinsley said, turning to Dr. Harris. He then added that North Carolina’s challenges are exacerbated because it is one of 14 states that has not expanded Medicaid to cover residents in households with incomes up to 138% of the federal poverty line.

It’s estimated that 144,000 people with substance-use disorders (SUDs) would gain coverage if North Carolina expanded Medicaid, Kinsley said.

The most stunning statistic Kinsley offered, however, is that—in the first two weeks after release from jail—people with a SUD in North Carolina are 40 times more likely than the general population to die, with an overdose being the typical cause.

“So, we literally say: ‘Thank you, you’ve done your time, you’ve been adjudicated, ready to go, and now you’re going to die,’” Kinsley said. “I cannot believe we operate a system where there is any kind of justice and that’s the outcome.”

On the positive side, Kinsley reported that North Carolina has received a $6.5 million federal grant that will be used to initiate SUD treatment for people in jail.

“This is transformative for North Carolina,” he said. “We’re going from two years ago having zero jail-based treatment programs to—hopefully in the next year—having 15.”

Both Kinsley and Dr. Harris said sustainable funding and a permanent infrastructure for SUD treatment are needed.

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Nondrug alternatives

Dr. Harris also discussed the need for safe storage and disposal of all medications.

“We cannot forget, in our appropriate zeal to address the opioid epidemic, that there are patients in pain right now who are struggling to get their medications,” she said.

Also essential as part of a prevention strategy is coverage for nonopioid, nonpharmacological alternatives to treat pain by payers—without high co-pays, Dr. Harris added.

The panelists agreed that SUDs should be treated like other chronic diseases such as diabetes or hypertension. This includes providing more evidence-based treatment and eliminating abstinence-based therapies that treat SUDs as a moral failing or character flaw.

While news of the human damage done by the opioid epidemic needs to be covered, Dr. Harris said the AMA is also exploring working with the media on telling stories of recovery.

“What’s not being covered as much are the success stories—the stories of people who have recovered, are working, have regained custody of their children, and are productive citizens,” she said.