Increased addiction education, treatment certifications, and prescription drug monitoring program adherence were among the physician-focused recommendations in the final report of the President’s Commission on Combating Drug Addiction and the Opioid Crisis, released Nov. 1.
The report recommends more than 50 action points for President Trump and Congress to employ to address opioid and substance misuse, which the president declared a public health emergency.
Strategies focusing specifically on health providers targeted insufficient training and education regarding responsible prescribing, addiction prevention, and substance use disorder treatment.
“Estimates suggest there are currently about 4,400 actively practicing certified addiction specialist physicians (addiction medicine and addiction psychiatry) in the country, but data on the specialty workforce is limited,” according to the report. “About 8 years ago, an estimate was made of the need for 6,000 addiction specialists, but that number is now insufficient given the growth of the opioid epidemic.“
The report recommended increasing the number of medical schools accredited to offer addiction medicine fellowships from 46 to 125 over the next 5 years and recommends using funds allocated to the Health Resources and Services Administration by the 21st Century Cures Act to do so starting in 2018.
Increased counseling on addiction risk when patients receive an opioid prescription also is crucial, according to the report, which cited a survey in which only 36% of patients reported they were properly informed before or while taking their medication.
The low number of physicians holding waivers to dispense buprenorphine (medication-assisted treatment) was another source of concern, especially among rural communities.
“None of the large central metro counties, and 72% of the rural counties, did not have a waived physician,” according to the committee report, which cited registration data from the Drug Enforcement Administration. “Findings from focus groups of counselors in rural areas noted a dearth of good facilities, poor access due to clients living far away from treatment centers, reliance on friends or family for transportation, and a need for basic medical and dental services.”
The committee has advised increased outreach to physicians regarding buprenorphine prescribing waivers, although it acknowledged that with the cap on patients per waived physician, increasing the number of waived physicians “is not necessarily indicative of sufficient access.”
The report also stressed a need for physicians to adhere more strictly to opioid prescribing guidelines from the Centers for Disease Control & Prevention and regular registration of opioid prescriptions in state-level prescription drug monitoring programs (PDMPs).
“Providers often resist using PDMPs because these systems are not well integrated into the electronic health record systems they currently use in practice,” the report noted. “Simplifying the method of access to PDMPs for providers by integrating PDMP data into health information exchanges [may increase] the likelihood that prescription history information will be used in clinical decision-making.”
Despite the recommendation, the committee recommended $12 million be spent on restructuring the program in the fiscal year 2018 federal budget, $1 million less than in 2017.
The committee also encouraged CMS to revise payment policies, including some bundled payments, that currently disincentivize the use of nonopioid treatment options as well as remove pain management measurements from patient surveys.
CMS announced in 2016 it would work to revise patient surveys starting in January 2017.
The American Medical Association, in a statement, expressed support of the committee’s recommendations.
“The AMA commends The President’s Commission on Combating Drug Addiction and the Opioid Crisis for delivering a comprehensive report that provides an excellent road map for increasing access to medication-assisted treatment for patients with substance-use disorders and also demonstrates the need to eliminate barriers to accessing the full spectrum of multidisciplinary pain treatment options,” said Patrice A. Harris, MD, chair of the AMA opioid task force. “The AMA is pleased that the commission agreed with many of the AMA’s previous suggestions, and we look forward to working with the Administration and Congress on next steps, including the needed financial resources.”
The President’s Commission on Combating Drug Addition and the Opioid Crisis is comprised of Gov. Chris Christie (R-N.J.), chairman; Gov. Charlie Baker (R-Mass.); Gov. Roy Cooper (D-N.C.); former Rep. Patrick Kennedy (D-RI.); Bertha K. Madras, PhD, Harvard Medical School, Boston; and Attorney General Pam Bondi (R-Fla.).*