Experts Tell Opioid Commission: Back Evidence-Based Treatment

Alicia Ault

June 16, 2017

President Donald Trump's administration should do all it can to support evidence-based addiction treatment and find ways to encourage more physicians to take on addiction medicine as a specialty, clinicians told members of The President's Commission on Combating Drug Addiction and the Opioid Crisis today.

The physicians who testified before the commission — and most of the other speakers — also urged the panel to strongly advocate against Medicaid cuts, especially those that have been proposed under the American Health Care Act, the Republican replacement for the Affordable Care Act.

"Medicaid is the largest national payer for mental illness and addiction treatment," said Joe Parks, MD, medical director for the National Council for Behavioral Health. "The Medicaid expansions must be maintained and completed," said Dr Parks, in his testimony.

Speakers also gave recommendations for prevention strategies, how to help increase naloxone supplies for first responders, and making more resources available for families attempting to cope with a parent, child, or sibling with addiction. And they said that insurers still did not generally obey the federal parity requirement — that mental health and substance use benefits be on par with physical health benefits.

The five-member commission held its first public meeting today, hearing from representatives of nine organizations involved in drug use prevention and treatment, along with the secretaries of the US Department of Health and Human Services (HHS) and the US Department of Veterans Affairs (VA). Also in attendance were representatives from the US Department of Education and Jared Kushner, the president's son-in-law and adviser, and Kellyanne Conway, a White House counselor.

Noting the stigma surrounding addiction, Commission Chairman Chris Christie said, "The biggest goal of this commission is to bring it up out of the shadows and into the light." Christie, who is also the Republican governor of New Jersey, said that Trump had a personal interest in addiction and would help ensure that the commission's work would be acknowledged and publicized.

"This is clearly one of the president's top priorities — to make certain we address this scourge," said HHS Secretary Tom Price, MD, who added that the opioid crisis is also one of the three clinical priorities at his agency.

"We Know What Works"

Addiction medicine specialists told the commission that the federal government should focus its policy efforts on supporting evidence-based therapies for opioid addiction.

"We need to make sure insurers are paying for evidence-based care, and not paying for treatment that is 'evidence-based,' " said Kelly Clark, MD, president of the American Society of Addiction Medicine. "We're paying for spa-like treatments and things not based in science," she said.

Evidence backs medication-assisted treatment for opioid addiction, said Dr Kelly, who said the federal government should permanently authorize physician assistants and nurse practitioners to prescribe buprenorphine to help treat opioid addiction.

"We know what works, and we need to make sure that is what is being funded," agreed John Renner, MD, president of the American Academy of Addiction Psychiatry. When it comes to medication-assisted treatment (MAT) for opiate use disorder, "we have the research that shows it's cost-effective as well as clinically effective," said Dr Renner, who is also associate professor of psychiatry at Boston University School of Medicine and associate chief of psychiatry for the VA in Boston, Massachusetts.

Gary Mendell, a former hotel executive who started the nonprofit group Shatterproof after his son died of an overdose in 2011, urged the commission to recommend immediate policy changes to ensure that more clinicians become MAT prescribers — such as eliminating the 8-hour training requirement.

He also said that the federal government should pay for all individuals whose insurance does not cover MAT, and suggested that the government act to eliminate insurers' prior authorization requirements for MAT.

More Specialists Needed

All the speakers said that treatment was rarely available when needed.

"We have a tremendous workforce issue because we don't have enough specialists," Dr Renner said. Training is scant-to-none in medical school and residency, and addiction treatment is not attractive to physicians who leave school laden with debt, he added. And, stigma is as strong in medicine as in the public, Dr Renner said. "Physicians are uncomfortable working with people with addiction problems."  

Jessica Nickel, president and CEO of the Addiction Policy Forum, said that only 10% of the 21 million in need of treatment were getting care. "Can you imagine if only 10% of Alzheimer's or cancer patients got treatment?" she asked.

"We increased our infectious disease specialists during the AIDS epidemic — we must take the same approach now," said Dr Clark, who said more funding should be directed to a section of the 21st Century Cures law, which provides training for addiction specialists who pledge to work in underserved areas.

"We should ensure the same high quality care is available for our citizens with opioid addiction that is available for heart disease," Dr Clark said.

The commission will deliver an interim report within a few weeks. A draft will be posted on the commission's website soon and will be discussed at its next public meeting on June 26. A final report will be delivered by October 1.

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