Recommendations From Researchers

Researchers recommend several measures to stem the opioid crisis:

·         Relax the regulations outlined in the Drug Abuse Treatment Act of 2000, in particular, those pertaining to requirements for physicians wishing to prescribe buprenorphine (ie, length of training course, number of patients treated).

·         Omit or limit the quantity of opioids prescribed to young people and monitor the substance use patterns of patients who were initially treated with opioids to manage acute pain (eg, from injury or surgery).

·         Conduct additional research to investigate the nature of factors that may predispose to OUD.

·         Screen older patients for previous nonmedical use of opioids and substance use disorders before prescribing them opioids.

·         Remove the stigma associated with OUD by recognizing this disorder as a treatable chronic disease with a favorable prognosis.

·         Develop services complementary to OUD treatment to help patients develop appropriate life skills.

·         Expand overdose prevention programs and community-based distribution of naloxone.

·         Conduct research for the development of nonopioid medications and nonpharmacologic alternatives for the management of chronic musculoskeletal, neurologic, and autoimmune pain.

·         Expand paid medical leave, reduce copays, and improve access to nonpharmaceutical approaches.

Researchers advocate for the expansion of evidence-based treatments of OUD. Treatments with methadone or buprenorphine were found to reduce opioid overdose mortality, opioid use crime, the transmission of hepatitis C and HIV, and to increase social functioning.2

Although the treatment of OUD with opioid agonists is endorsed by the World Health Organization, the American Medical Association, the National Institute on Drug Abuse, the Office of National Drug Control Policy, and the Centers for Disease Control and Prevention, fewer than half of substance abuse treatment facilities offer patients these options.2

“Reasons for this shortfall in treatment availability may be plentiful, but stigma associated with drug addiction has created a climate in which abstinence is valued over effective treatment,” noted the article’s authors.1 “Often this preference is centered on an ethical argument that agonist therapy is merely replacing one drug with another.”

Engaging Policymakers

Although research studies have identified an array of effective treatment interventions for OUD, these have not widely been taken into account by policymakers when crafting related regulations.1 Engaging policymakers may help bridge the gap between evidence and policy.1

A group of nearly 120 health researchers, clinicians, policymakers, healthcare administrators, and other stakeholders met at the University of Pennsylvania in June 2017 to generate evidence-based policy recommendations to address the opioid epidemic and foster relationships between researchers and policymakers.1

Thirteen policy recommendations emerged across 4 themes: quality of treatment, continuity of care, opioid prescribing and pain management, and consumer engagement:

1. Tie insurer payment to minimum standards for evidence‑based treatments and continuity of care.

2. Eliminate or reduce the burden of regulations on buprenorphine prescribing.

3. Create an independent accreditation body to provide a complete list of available treatment centers and quality scores for treatment facilities.

4. Assure in‑person or telephone care coordination following discharge after a nonfatal opioid overdose through peer support or providers who prescribe medications for OUD.

5. Ensure primary care physicians feel comfortable and supported when prescribing medications for OUD.

6. Promote the initiation of buprenorphine treatment in emergency departments prior to discharge or hospital admission.

7. Require insurance companies to cover alternative pain treatment modalities to avoid having opioids be the default pain management option.

8. Tie the use and development of prescription guidelines to federal funding.

9. Develop a state scorecard on prescribing that ranks the states in relation to their goals.

10. Create an Airbnb‑type system of treatment facilities and providers and allow patients to sign up directly.

11. Develop a social marketing campaign for consumers of opioids and their relatives.

12. Set up a consumer‑driven rating system or recorded metric of programs for the treatment of OUD.

13. Fund programs that incentivize individuals to seek treatment for OUD.

The group plans to further investigate the feasibility of these recommendations and keep the lines of communication open among clinicians, researchers, and policymakers.

References

1. Heimer R, Hawk K, Vermund SH. Prevalent misconceptions about opioid use disorders in the United States produce failed policy and public health responses. Clin Infect Dis. 2019;69:546-551.

2. Miclette MA, Leff JA, Cuan I, et al. Closing the gaps in opioid use disorder research, policy and practice: conference proceedings. Addict Sci Clin Pract. 2018;13(1):22. 

This article originally appeared on Clinical Pain Advisor