There's no end in sight, the AAFP recently reminded HHS: Chronic pain continues to burden patients in a fragmented medical system that's not designed to care for them effectively.
But there are effective ways to manage patients' chronic pain while dealing with the public health crisis of opioid misuse, and the Academy recently sent HHS detailed guidance on how family physicians can continue to lead on this front.
For example, payment models should be adjustable -- and public and private insurance coverage of medication-assisted treatment less limited -- so physicians can provide patient-centered, compassionate care in the treatment of chronic pain and opioid dependence.
Those were among the key takeaways of the Academy's Aug. 28 letter(4 page PDF) to Brenda Destro, Ph.D., HHS' deputy assistant secretary for planning and evaluation, which was sent in response to a request for information(www.govinfo.gov) on how to ensure both patient access to opioids and other controlled substances, as well as effective drug law enforcement, published in the July 26 Federal Register.
The correspondence, signed by Board Chair Michael Munger, M.D., of Overland Park, Kan., centered on five topics identified by HHS.
Obstacles to Legitimate Patient Access
Unsurprisingly, this was the letter's longest, most critical section. Also not a shock: The hurdles named by the Academy were primarily related to payment, access to appropriate care (including MAT) and administrative complexity that takes time away from direct patient care.
Topping the list of obstacles the AAFP said HHS should address was the issue of inflexible payment models that may not appropriately compensate physicians for, among other things, the increased time, staff and regulatory commitments associated with MAT.
Among other barriers the Academy cited were
- the time-consuming need for physicians to consider obtaining a waiver(www.samhsa.gov) to deliver office-based opioid treatment,
- arbitrary limits on prescribed pain medications and
- pharmacy protocols that interfere with physicians' prescriptions based on a misapplication of CDC prescribing guidelines.(www.statnews.com)
Diversion of Controlled Substances
State prescription drug monitoring programs, the Academy said, should be used "to obtain information on suspected abuse or diversion and to help identify patients at risk so they can benefit from early intervention."
Law Enforcement/Pharmaceutical Industry Collaboration
The AAFP advised HHS to review current practice patterns and protocols with the goal of helping patients and preventing the diversion or misuse of controlled substances.
The letter also recommended better access to naloxone and "Good Samaritan" protections for prescribers and lay rescuers where these are needed.
Education, Training and Clinical Guidance
Residency training should be aligned to deliver evidence-based information on best practices for managing chronic pain and opioid dependence, the Academy wrote. In addition, CME offerings should be updated to address these issues, including through prescribing naloxone.
The Academy also called for expanded opportunities for waiver training during residency, as well as at national, state and regional CME meetings (including through online and other alternative models).
Better Reporting Requirements
HHS should improve reporting requirement as a way to ensure that the public and Congress have a better understanding of issues surrounding prescription opioids. One step, the Academy said, would be to facilitate overdose education and naloxone distribution programs at the community level.
Additionally, the AAFP called for more collaboration to support MAT between primary care and community behavioral health services, nurse care management services and other psychosocial support services. Further, waivered solo family physicians in rural and underserved areas should have expanded cross-coverage opportunities, and HHS should consider the possible short-term use of nonwaivered physicians to provide coverage.
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