AMA Policies for OUD, Pain and Harm Reduction
Like the earth revolving around the sun, so has been our concern surrounding COVID-19. This flare of a disease has captured our attention and turned our world upside down. And even though society has begun to slowly show signs of life, this virus’ gravitational pull has left a wake of destruction.
Death, illness, economic downturn and mental unrest are but the byproducts of this pandemic. And while we have all felt its impact, there are others who are more susceptible to its devastation.
Addiction is not merely a character flaw. Rather, it is a medical affliction that changes the function of your brain. Through brain scans, scientists have been able to identify variances in areas that are imperative for judgment, decision-making, learning, memory and behavior control, specifically in those that suffer from addiction.
When first used, drugs work as a stimulus on the brain’s reward system. The brain then releases pleasure boosting chemicals, but over time, more of the drug is needed to achieve that original “high.” And “chasing the dragon” becomes all consuming. When they’re not using, addicts will feel sick, anxious and irritable.
As this pandemic continues, so does the problem with substance abuse disorder (SUD).
With a growing number of national, state and local media reports indicating an increase in opioid-related deaths and concerns for those with mental illnesses or SUDs, the American Medical Association (AMA) is taking action. It recommends policies for opioid use disorder (OUD), pain and harm reduction.
Recently issuing the brief, “COVID-1 policy recommendations for OUD, pain, harm reduction,” the AMA has provided a detailed list of policy recommendations to help states save lives, reduce harm and get people the treatment they need during this global pandemic.
AMA Recommended Policies
(Information pulled from brief)
1. Access to Care for Patients with an OUD
- Adopt the new U.S. Drug Enforcement Administration (DEA) guidance, which provides flexibility for physicians managing patients with OUD. This includes authorizing prescriptions via telephone for buprenorphine for the treatment of OUD to new and existing patients.
- Issue medications, such as buprenorphine, methadone, naltrexone, to treat addiction; and medications, such as naloxone, to reverse opioid-related overdoses. This would be considered as “essential services” to reduce barriers to access during the stay-at-home orders. The U.S. Drug Enforcement Administration (DEA) guideline has already waived federal requirements for in-person visits before prescribing controlled substances; therefore, the AMA is encouraging states to follow suit.
- Prohibit cost-sharing and prior authorization for medications used to treat addiction. And allow for a 90-day prescription for patients receiving buprenorphine.
- Encourage states to request a blanket exception to SAMHSA for Opioid Treatment Programs (OTP) in order to receive take-home doses of a patient’s medication for OUD.
- Remove any restrictions on the Medicaid preferred drug lists to help avoid shortages. This includes ensuring coverage for methadone for patients receiving care in an OTP.
- Temporarily waive strict requirements for submitting drug tests, in-person counseling and “check-ins.” Correctional and justice settings should also suspend the punitive consequences received for failure-to-meet strict reporting, counseling and testing requirements, including removal from public housing, loss of public benefits, and return to jail or prison. Additional efforts must be taken to ensure people receiving medication assisted treatment (MAT) get help in transitioning to care after release from a correctional setting.
2. Protecting Patients with Pain
- Adopt DEA guidance, which authorizes physicians to prescribe opioid medications to existing patients without an in-person evaluation; and thus authorizing the prescription to be sent to the pharmacy via telephone.
- Waive limits and restrictions on prescriptions for controlled substances.
- Waive requirements for electronic prescribing of controlled substances, including requirements for an in-person evaluation for patients requiring a refill; while providing liability protections for physicians, who prescribe controlled substances for current patients that are stable and compliant with their medications.
- Waive testing requirements and in-person counseling requirements for refills for patients with chronic pain; and allow for telephonic counseling.
- Enhance home-delivery medication options for patients with chronic pain.
- Remove additional barriers to pain treatment to help ensure that patients with pain have access to treatments prescribed by their physician.
3. Harm Reduction to Help Prevent Overdose and Spread of Infectious Disease
- Issue supplies provided by harm reduction organizations as “essential services” to reduce barriers to access during stay-home orders.
- Provide assistance to harm reduction organizations to help ensure adequate supplies of naloxone.
- Ensure continuity of syringe services programs, including provisions of personal protective equipment (PPE). In an effort to protect against the spread of infectious disease, expand PPE priority to include harm reduction organizations and other community-based organizations that provide services to people who inject drugs.
- Implement specific policies to increase access to sterile needle and syringe exchange services.
- Emphasize the importance of naloxone to help save lives from opioid-related overdose. The AMA Opioid Task Force has identified several factors physicians should consider when prescribing naloxone to patients. Patients are encouraged to take advantage of state standing orders, which allows them to the medication directly from a pharmacy without a patient-specific prescription.
- Include in future grant requests an emphasis on sterile needle and syringe services programs.
This is new territory for all of us, but for those battling addiction, it’s problematic. So it’s important now more than ever to stay abreast of patient care, treatment and what our legislators can do and are doing to help.