Solutions for the Opioid Epidemic

Federal policy should view opioid use disorder as a public health concern in order to save lives and prevent future addiction crises from occurring. While progress has been made, work remains to be done.

Americans die every day from opioid overdose.1Hefei Wen, Tyrone F. Borders, and Janet R. Cummings, “Trends In Buprenorphine Prescribing By Physician Specialty,” Health Affairs 38, no. 1 (January 1, 2019): 24-28,28A-28B, http://dx.doi.org/10.1377/hlthaff.2018.05145; Laura A. Schmidt, “Recent Developments in Alcohol Services Research on Access to Care,” Alcohol Research: Current Reviews 38, no. 1 (2016): 27–33; Greg Allen, “Cost Of U.S. Opioid Epidemic Since 2001 Is $1 Trillion And Climbing,” National Public Radio, February 13, 2018, https://www.npr.org/sections/health-shots/2018/02/13/585199746/cost-of-u-s-opioid-epidemic-since-2001-is-1-trillion-and-climbing.

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Cost of the opioid epidemic to the US annually, nearly 3% of total GDP.

$500B
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Solutions for Better Mental Health

Access to Effective Treatment

Most Americans do not have access to evidence-based treatments for addiction (regardless of their insurance) and very few have access to the full continuum of effective services. Without access to effective treatments, addictions become all the more disabling and even deadly.

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  • The federal government should encourage the use of evidence-based treatments, including Medication-Assisted Treatment (MAT).
  • All physicians should receive training on addiction in medical school and should then be able to prescribe MAT without separate training and waiver. This would require a reform to the DATA 2000 waiver.
  • The federal government should amend the Medicaid and Medicare statutes to substantially strengthen access to effective substance use treatments. Medicare and Medicaid should cover the full range of effective substance use treatments. These treatments should be mandatory benefits in Medicaid, which would build on the addition of MAT as a mandatory Medicaid benefit in the SUPPORT Act. The federal government should clarify how these treatments are covered under the Essential Health Benefits, which apply to exchange and Medicaid expansion, and parity for commercial plans. The federal government should also work with states that have not expanded Medicaid to identify solutions for ensuring coverage of low-income individuals.2The Editorial Board, “States Show the Way on the Opioid Epidemic,” The New York Times, August 24, 2018, sec. Opinion, https://www.nytimes.com/2018/08/24/opinion/opioid-epidemic-states.html. 3Lisa Clemans-Cope, Victoria Lynch, Emma Winiski, Marni Epstein, “State Variation in Medicaid Prescriptions for Opioid Use Disorder from 2011 to 2018” August 21, 2019 https://www.urban.org/research/publication/state-variation-medicaid-prescriptions-opioid-use-disorder-2011-2018 4Colleen M. Grogan et al., “Survey Highlights Differences In Medicaid Coverage For Substance Use Treatment And Opioid Use Disorder Medications,” Health Affairs 35, no. 12 (December 10, 2016): 2289–96, http://dx.doi.org/10.1377/hlthaff.2016.0623.
  • On the private insurance side, the federal government should enact new protections for MAT by requiring health plans to cover FDA-approved medication for SUD if medically necessary.
  • The federal government should eliminate the limit on the number of patients clinicians can treat with MAT, like buprenorphine.5Congresswoman Lori Trahan, Congresswoman Lori Trahan Leads Bipartisan Introduction of Medication Access and Training Expansion (MATE) Act, Opioid Addiction Treatment and Training Legislation, With Representatives Bergman, Carter, Trone, Rogers, and Kuster Official Press Release, November 1, 2019.
  • CMS should create an expedited application process for coding MAT drugs with the Healthcare Common Procedure Coding System to streamline activities/oversight.6“Recommendations of Congressman Patrick J. Kennedy to the President’s Commission on Combating Drug Addiction and the Opioid Crisis.”
  • The federal government should also make MAT more accessible by directing the Health Services and Resources Administration to ensure that MAT is offered at all Federally Qualified Health Centers (FQHCs) and require all FQHCs clinicians to get DATA 2000 waivers to prescribe buprenorphine.
  • The federal government should allocate additional funding and authorize uses of existing federal funding to support different stakeholders in forming, joining, and sustaining community coalitions focused on improving addiction and overdose outcomes. This should include Medicare and Medicaid, as is currently being piloted with the Accountable Health Communities Model.
  • The federal government should direct the Centers for Medicare and Medicaid Services to issue an order that all state Medicaid programs must cover FDA-approved MAT drugs without prior authorization.
  • The federal government should direct the Department of Health and Human Services, in consultation with the American Society of Addiction Medicine (ASAM), to develop model standards for the regulation of SUD treatment programs based on the Levels of Care standards set forth in the most recent version of The ASAM Criteria and condition receipt of certain federal grants on state adoption.
  • The federal government should remove the legislative and regulatory barriers that prevent the use of federal funds for syringes used in syringe service programs (SSPs).
  • The federal government should direct the National Institute of Health to provide more grants to researchers looking into treatment for SUD.
  • The federal government should build multi-stakeholder opioid safety coalitions. The federal government should support these coalitions by providing grants to states.

Limit and Regulate Opioid Prescribing

One strategy for reversing the tide of the opioid overdose epidemic is limiting the flow of prescription drugs. Providers still need to be able to effectively manage pain, but prescription opioids should be prescribed according to CDC guidelines.7“CDC Advises Against Misapplication of the Guideline for Prescribing Opioids for Chronic Pain.” Center for Disease Control April 24, 2019. https://www.cdc.gov/media/releases/2019/s0424-advises-misapplication-guideline-prescribing-opioids.html Individuals should also have access to a range of alternative pain management treatments. Beyond reducing addiction risk, these strategies lower emergency department readmissions and overall costs for hospitals.8Diomaris E. Jurecska et al., “Pain: The Continuing Epidemic,” in Pain Management Yearbook 2012, ed. Joav Merrick, Health and Human Development (Nova Biomedical Books, Hauppauge, NY, 2013), 323–30, Chapter xvii, 460 Pages.

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  • The federal government should limit and regulate opioid prescribing by making educational grants and funding for medical programs contingent on their inclusion of safe-prescribing practices in curricula.
  • The federal government should address the importance of clinically-indicated and evidence-based utilization management processes for ensuring that opioids are not inappropriately prescribed in Medicare and Medicaid.9“CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016,” MMWR. Recommendations and Reports 65 (2016), https://doi.org/10.15585/mmwr.rr6501e1er. The federal government should also initiate a multi-payer effort to encourage commercial insurers to adopt similar practices.
  • The federal government should ensure that Medicare covers evidence-based alternatives for pain management, and fund systematic reviews that indicate how such therapies would fit within medical necessity guidelines of commercial plans.10Erin E. Krebs et al., “Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain or Hip or Knee Osteoarthritis Pain: The SPACE Randomized Clinical Trial Opioid vs Nonopioid Medications on Pain-Related Function Opioid vs Nonopioid Medications on Pain-Related Function,” JAMA 319, no. 9 (March 6, 2018): 872–82, https://doi.org/10.1001/jama.2018.0899.
  • The federal government should provide incentives in its funding for health care educational programs to include training on safe prescribing and related practices for minimizing risk of addiction.
  • The federal government should publicize Take Back Days or implement permanent Take Back Programs, including funding the installation of permanent drug take-back drop-off boxes in federal facilities located in cities around the country.11“Opioid Medication Disposal Programs: Reviewing Their Effectiveness | Clinical Drug Information,” accessed June 17, 2019, https://www.wolterskluwercdi.com/blog/opioid-medication-disposal-programs-reviewing-their-effectiveness/; Jeffrey Gray et al., “Prescription Disposal Practices: A 2-Year Ecological Study of Drug Drop Box Donations in Appalachia,” American Journal of Public Health 105, no. 9 (September 2015): e89–94, https://doi.org/10.2105/AJPH.2015.302689.
  • The federal government should encourage states and local governments to raise awareness of the National Prescription Drug Take Back Day (October 26) or institute state-wide versions of the same drug-reduction effort.

Overdose Reversal Drugs

Naloxone is an opioid-antagonist that can counteract opioid overdose and is simple enough to be administered by a minimally trained layperson.12“Understanding Naloxone - Harm Reduction Coalition,” accessed June 26, 2019, https://harmreduction.org/issues/overdose-prevention/overview/overdose-basics/understanding-naloxone/. But while almost every state allows pharmacists to dispense Naloxone without an individual prescription, it remains underutilized.13Rachel Balick, “Patients Can Get—and Pharmacists Can Provide—Naloxone at the Pharmacy. Why Don’t They?,” American Pharmacists Association, July 10, 2018, https://www.pharmacist.com/article/patients-can-get-and-pharmacists-can-provide-naloxone-pharmacy-why-dont-they.

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  • The federal government should mandate that naloxone be available in all federal facilities (e.g. post offices).
  • Federal laws should be adjusted to require coverage of naloxone without co-pay by public and private insurers, and require co-dispensing naloxone with long-term (i.e., longer than a week) opioid prescriptions, which evidence suggests could cut opioid-related emergency visits by half within a year.14Townley and Dorr, “Integrating Substance Use Disorder Treatment and Primary Care.”
  • The federal government should make certain funding contingent on states implementing naloxone training programs for first responders and community members in relevant funding programs.
  • The federal government should investigate making naloxone have an over the counter (OTC) status, but at a minimum, have a standard order or protocol in place.

Prescription Drug Monitoring Programs (PDMPs)

Prescription Drug Monitoring Programs (PDMPs) offer databases that can track prescribing and dispensing of opioids to identify people who may be diverting or misusing drugs; establish responsible prescribing practices; and prevent patients from “doctor shopping” to find a physician who will prescribe them opioids. PDMPs can also limit the number of pharmacies where patients with high addiction risk can receive prescriptions.15“CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016.”

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  • The federal government should increase the efficacy of PDMPs by funding technical assistance and learning collaboratives for states, including facilitating data sharing between states, or by creating a nationwide PDMP.
  • The federal government should build provider incentives for using PDMPs into existing programs that incentivize the use of health information technology.
  • The federal government should increase the efficacy of PDMPs by directing the Department of Health and Human Services to issue a report on how to build a nationwide ctaPDMP or facilitate data sharing between states.

Tailored Policies for Unique Needs

To be effective, mental health solutions need to address individuals' range of identities based on race, ethnicity, language, gender, or gender identity, sexual orientation, disability, veteran's status, or life circumstances. We recommend meaningful policies to combat a harmful legacy of one-size-fits-all solutions.

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Spotlight on the Opioid Epidemic

Read our proposed solutions for the nation’s deadly crisis.

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