June 13, 2018, 11:34 am News Staff – The AAFP this week teamed up with five other medical organizations to release guidance titled "Addressing the Opioid Epidemic: Joint Principles," which is intended to inform congressional policies addressing the nation's opioid use disorder (OUD) epidemic.
The other organizations that adopted these principles are the American Academy of Pediatrics (AAP), American College of Obstetricians and Gynecologists (ACOG), American College of Physicians (ACP), American Osteopathic Association (AOA), and American Psychiatric Association (APA). Together, the groups represent more than 560,000 physicians and medical students.
Among other things, the joint principles call on Congress to adopt policies that recognize OUD as a chronic disease of the brain that requires comprehensive treatment. They also urge policymakers to implement solutions that focus on families grappling with other serious substance use disorders (SUDs) as they take steps to address the immediate opioid crisis.
"As a society, we need to ensure that people struggling with opioid use disorder -- and this includes family members as well as patients -- have access to comprehensive care," said APA President Altha Stewart, M.D., in a group statement.
"Just like people with any other chronic illness, these patients must have coverage for treating a chronic brain disease. The doctors who treat them must be able to respond quickly during relapses and to provide ongoing care management without administrative delays that can lead to emergencies, inpatient care or other high-cost treatment."
The joint principles call for a public health approach to SUDs that aims to reduce stigma while striving to ensure comprehensive pain management for patients. They also offer specific guidance on expanding access to treatment and increasing research into SUD prevention and treatment.
Emphasizing that an SUD is a chronic disease of the brain that can be effectively treated, the principles document calls for a variety of legislative and regulatory approaches to tackling this public health issue.
Reduce the administrative burden associated with providing patients effective treatment. The current process of obtaining prior authorization for services and/or dispensing medications for an OUD is burdensome and delays access to life-saving care, the document notes.
"When patients seek treatment for opioid use disorder, they need to get it now," said AAFP President Michael Munger, M.D., of Overland Park, Kan., in the group statement. "They can't wait until the doctor has obtained prior authorizations for services or for dispensing medications. We're pleased some insurers have lifted prior authorizations for medication-assisted treatment, but we need to see more progress in order to minimize delays and increase the time physicians can spend with their patients."
Align and improve financing incentives to ensure access to evidence-based OUD treatment. Protecting Medicaid's viability and maintaining its current financing structure, among other points, can help improve access to OUD treatment.
"Persons with low income who are struggling with opioid use disorder must have access to Medicaid coverage," said ACP President Ana María López, M.D., M.P.H., who called for extending coverage to adults in nonexpansion states and maintaining Medicaid's existing financing structure without caps or other changes.
"Equally important, policies should mandate that Medicaid and Medicare pay for comprehensive medication-assisted treatment at the same rate they pay for other chronic illnesses," she added.
Incentivize more health care professionals to treat SUD. A critical component to stopping the opioid epidemic is making sure there are enough physicians to help treat those with SUDs in need, the principles contend.
"We must ensure that patients have access to health professionals who can meet their needs," said the APA's Stewart. "An estimated 2.1 million Americans suffer from untreated SUDs. If we're going to have a strong behavioral health workforce, our policies must provide incentives, such as education loan forgiveness, for those who provide care in underserved areas."
Advance research to support prevention and treatment of SUDs. Additional research is needed to inform optimal treatment to combat the opioid crisis, the principles note.
"One of the most important elements of preventing and treating substance use disorders is understanding the safety and effectiveness of alternatives to opioid medications," said ACOG President Lisa Hollier, M.D., in the statement. "Many of today's nonopioid pain relief options are contraindicated for use during pregnancy. The National Institutes of Health must have the tools and flexibility to support innovative research on alternatives to opioids and appropriate opioid prescribing to treat pain without triggering addiction."
Address the maternal-child health impact of the opioid crisis. Increasing access to evidence-based treatment for pregnant and parenting women will improve maternal and child outcomes.
"Parental substance use has a significant impact on child health and well-being," said AAP President Colleen Kraft, M.D., M.B.A., in the statement. "More than a third of children entering foster care do so at least in part because of parental substance use. However, the science tells us that we can often better address the needs of affected families by providing access to evidence-based treatment for the whole family.
"We need policies that support access to familial treatment and prevent unnecessary foster care placements when children can remain safely with their parents, including effective implementation of the Family First Prevention Services Act of 2017."
Continue to provide comprehensive pain management for patients. Although fighting the opioid epidemic is the priority, the principles recognize that physicians still need to help manage their patients' long-term pain.
"It's vitally important that we take care of patients suffering from chronic pain, who are the most common recipients of opioid medications," said AOA President Mark Baker, D.O., in the statement. "While our policymakers focus on preventing opioid misuse, they also must ensure that patients suffering debilitating, chronic pain have access to the most appropriate treatment."
Ensure a public health approach to SUDs by addressing childhood stress, access to naloxone, and fair and appropriate treatment for individuals in the criminal justice system and pregnant women.
"Opioid use disorder is a public health crisis, and our policies must take a comprehensive public health approach to it," said Munger. "With that focus, we can avoid long-term, adverse health consequences from children who suffer from trauma associated with a family member who has an untreated opioid use disorder.
"We will save lives by providing targeted distribution of naloxone in the community. And we can prevent relapse and death among former inmates who had inadequate SUD treatment during their incarceration."
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