Colorado leads opioid prevention

Friday, September 01, 2017 12:37 PM

And it’s time to take the next step

by Patrice A. Harris, MD, MA, AMA Opioid Task Force Chair

Physicians should be proud reading this issue of Colorado Medicine because it highlights the dedicated steps clinicians are performing daily to reverse Colorado’s opioid epidemic. This information, coming from state legislators, practicing physicians, leaders in harm reduction and other policy advocates, represents the forward momentum that is essential for Colorado’s long-term health. It also provides a backdrop as to why the state is seeing progress on several fronts.

Physicians and other health care professionals used the Colorado state prescription drug monitoring program (PDMP) more than 1.5 million times in 2016 (a 122-percent increase from 2014), decreased opioid prescriptions by nearly half a million since 2013, and instituted one of the most wide-ranging naloxone access and Good Samaritan laws in the country. The AMA has commended the work of the Colorado Consortium for Prescription Drug Abuse Prevention, which is among the nation’s finest group of stakeholders working together to end harms from opioid-related misuse. As a public health physician, I know firsthand that working across disciplines throughout the community is the most effective way to achieve positive change.

I am proud to say that these state-level efforts are also being seen across the country – with national PDMP use up 121 percent since 2014 to more than 136 million queries; and national opioid prescribing decreasing by nearly 17 percent since 2012. In addition, over the past two years, more than 100,000 physicians have taken continuing medical education and training courses related to opioid prescribing, pain management, substance use disorders treatment and related topics. Every state now has a naloxone access law, and physicians are co-prescribing the life-saving opioid reversal drug more than ever before. To further encourage physicians to make use of PDMPs, to make available meaningful state- and specialty-specific education, and to become trained to provide in-office buprenorphine to patients, the AMA has launched a new opioid microsite (www.end-opioid-epidemic.org) that includes key resources specifically for Colorado physicians (www.end-opioid-epidemic.org/colorado).

These are signs of progress, but we all know that this progress is tempered by the reality of opioid-related overdose and death. The AMA will continue to pursue implementation of the recommendations of our Opioid Task Force, but you will also see a renewed emphasis in three key areas that must occur to end this epidemic.

First, we need to increase access to specialists in addiction medicine and pain. This will require policymakers and the health care community working together to increase the number of trained specialists. As provider network rules are enforced, advocates and policymakers need to consider alternative access plans that allow for timely access to care, especially in rural or isolated communities that are common in Colorado. That might mean that patients are able to see providers outside their network without being penalized, and that we consider additional, innovative ways to provide care for patients. When patients seek help for an opioid use disorder – or need comprehensive care for chronic pain – care delayed often means continued harm, and in some cases, could mean the difference between life and death. This is critically important as more patients now are dying from heroin and illicit fentanyl than from overdoses due to prescription opioids.

Second, we need to remove administrative barriers that stand in the way of care. For example, health insurers should remove prior authorization requirements for medication assisted treatment (MAT) as well as address other similar barriers to non-opioid and non-pharmacologic pain care. The evidence is unequivocal that MAT is effective and saves lives, and several national insurers have already taken steps to remove prior authorization barriers. All of Colorado’s insurers should follow suit.

Finally, patients need access to MAT, as well as alternatives for pain management. As the nation seeks to change the paradigm for treating pain and encourages physicians to recommend all appropriate pain management modalities to patients, insurance plans need to cover those treatments. It is also critical that advocates seek enforcement of parity laws and other requirements concerning coverage of mental and behavioral health care.

Stakeholders should consider the impact of benefit designs and patient cost-sharing on the affordability of treatments. Here in Colorado, employers need to recognize that patients may require time away from work to participate in therapeutic modalities so opioid analgesics are not the only affordable option.

These three steps – improving access and availability to treatment for substance use disorders and pain; removing prior authorization for MAT; and increasing coverage for non-opioid pain therapies – are areas where physicians, policymakers and stakeholders can work together. The authors of the articles in this issue are leaders in reversing the opioid epidemic. The AMA stands ready to work with them – and all physicians in Colorado – to help get it done.