The AMA and Manatt Health have released a policy roadmap identifying effective state-based policy solutions to combat the drug overdose epidemic.
The report emphasizes the increasing importance of removing barriers to evidence-based care—including prior authorization for medications to treat opioid use disorder and increasing access to non-opioid pain alternatives. Further, it highlights how the COVID-19 pandemic has complicated treatment and exposed gaps in how substance use disorder (SUD) is treated while drug-related overdose deaths increase, according to the CDC.
The analysis provides recommendations to governors, state legislators, attorneys general, insurance commissioners, Medicaid officials and other policymakers, and highlights the need to directly address long-standing inequities in access to SUD treatment for Black Americans and other minoritized and marginalized communities. The 2020 analysis expands on AMA and Manatt Health’s 2019 report and offers a mixed assessment of the progress, as states continue to grapple with the epidemic.
The national roadmap highlights six key areas where regulators, policymakers and other stakeholders can act:
- Improving access to evidence-based treatment for opioid use disorder. Remove prior authorization and other barriers, including affordability, to medications for treating opioid use disorder.
- Enforcing mental health and substance use disorder parity laws. Increase meaningful oversight and enforcement of parity laws, including requiring payers to demonstrate compliance prospectively as part of the product approval process.
- Addressing network adequacy and enhancing workforce. Ensure access to addiction medicine physicians, psychiatrists and other health care professionals.
- Expanding pain management options. Enhance access to comprehensive pain care, including multidisciplinary, multimodal care for patients with pain.
- Improving harm reduction efforts. Reduce harm by expanding access to the overdose-reversing drug naloxone and coordinating care for patients in crisis. Harm reduction also must include increased access to sterile needle and syringe services.
- Enhancing monitoring and evaluation. Implement programs that monitor and evaluate policies and outcomes to identify what is working, and then build on those successes.
“Sadly, the drug overdose epidemic continues, and it has become more complicated during the COVID-19 pandemic,” said Patrice A. Harris, MD, MA, Immediate Past President of the AMA and chair of the AMA Opioid Task Force. “It is long past due for all stakeholders to remove barriers to care and address systemic inequities that have been brought to light during this pandemic. Physicians and other health care professionals will continue to take action, and the AMA is willing to work with all stakeholders to implement these recommendations to prevent future deaths.”
If people can’t access treatment for a substance use disorder close to where they live, they might not get any treatment, said Justine Welsh, MD, a child and adolescent and addiction psychiatrist and Director of the Emory Healthcare Addiction Services.
Having evidence-based care for substance use disorders throughout Georgia is just one goal of a new partnership between Emory Healthcare and the Hazelden Betty Ford Foundation. The Atlanta-based health system and the national, non-profit addiction treatment provider created the Addiction Alliance of Georgia in a multi-year partnership that seeks to build wide-ranging treatment access for patients with a substance use disorder as well as promote evidence-based research and education efforts for Georgians throughout the state.
“We’re going to put treatment where it is needed most by building networks throughout the state,” said Dr. Welsh. “This partnership will help to reduce transit times to treatment, enhance telehealth options and help build community-based linkages.”
Treatment options, according to Dr. Welsh, will be tailored to the needs of patients, and could include telehealth consultations, hospitalization or intensive outpatient care. Emory already has started to build out pilot programs, and Hazelden Betty Ford is providing its well-established model for addiction care for the planned treatment programs. The alliance also is developing education and training resources for use in the community.
“We’re going to build out the program as the partnership grows,” said Steve Delisi, MD, an addiction psychiatrist and Medical Director for Hazelden Betty Ford’s Professional Education Continuum Solutions. “We’re basing our effort on a fully integrated model of care, which includes medications like buprenorphine, and it also will include education and prevention in the form of community workshops, school prevention programs and related efforts throughout the state.”
Jan. 6-8: This year's AMA State Advocacy Summit (SAS) comes at a pivotal time for states as they face difficult legislative sessions where lawmakers will be crunched by budgets and pressure to take drastic actions to curb the COVID-19 pandemic and shore up public health infrastructure. The theme, A new year brings big questions, will encompass not just protecting and advancing health care in a time of crisis, but also touch on the continued advancement of telehealth and updates on the state of the overdose epidemic. Delivering the keynote speech will be political strategist Bruce P. Mehlman, who will discuss The Great Acceleration exploring how the recent elections and year of pandemic were influenced by long-running technological, cultural and geopolitical trends and how the events of 2020 will impact those trends going forward.
The meeting will be held virtually Jan. 6-8, running each day from 1-4 p.m. Central time. Registration is now open and there is a $50 discount when you register for SAS and the AMA National Advocacy Conference which will also be held virtually, Feb. 23-24.
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AMA's COVID-19 advocacy efforts
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COVID-19 health equity initiatives across the United States