News came out in mid-April that rock mega-star Prince had many prescriptions for opioid drugs in his home at the time of his death April 21 last year. But the prescriptions were in the name of his bodyguard, bringing to light a common occurrence in the world of opioid misuse: Many people get started down the path to dependence and addiction by tapping into other people’s prescription painkillers. Or they may use multiple identities to get more drugs than are safe to use. Despite all of the statistics, there is good news buried in all of this tragedy: treatment works! Obstacles to getting treatment still exist, but they are starting to be addressed. This help can’t come soon enough, considering Americans now use prescription painkillers at a higher rate than tobacco products.
Barriers to treatment slowly breaking down
Progress is being made on the following fronts as regulators, legislators and the healthcare industry tackle the opioid crisis:
Insurance pre-authorization and coverage. Three major insurers have recently removed the barrier of pre-authorization requirements for medication that reduces the difficult symptoms of opioid withdrawal. As anyone in recovery can tell you, it doesn’t take much to discourage a person in the first hours, days and weeks of weaning themselves off a substance. With Aetna, Anthem and Cigna removing pre-authorization requirements for medication-assisted treatment, the pressure on other insurers could grow.
Adequate funding. The opioid crisis received additional visibility in late April when Tom Price, secretary of the U.S. Department of Health and Human Services said he wants a broad review of the agency’s approach and encouraged doctors to rethink pain management. Price has promised $485 million in prevention and treatment grants authorized by last year’s 21st Century Cures Act. Another half-billion in state grants are pledged for next year.
Restrictions on physicians. A limited number of physicians are trained to prescribe medications that assist with withdrawal and their availability varies dramatically by state. Physicians trained in this care are restricted by the federal government as to how many patients they can treat with these medications – a limit intended to prevent pill mills from arising. Price has said he wants to lighten up these rules.
Stigma. Overcoming the stigma associated with dependence and addiction is still a challenge. Research shows that many Americans have trouble recognizing addiction as a disease.
“We have to stop treating addiction as a moral failing, and start seeing it for what it is: a chronic disease that must be treated with urgency and compassion,” said U.S. Surgeon General Vivek H. Murthy, MD, MBA, in 2016.
He encouraged physicians in a report called Turn the Tide to assume a proactive role in addressing the crisis.
Practical information for primary care physicians in free April 26 webinar
ABILITY was honored to co-host a free webinar in April 2017 in conjunction with the Hazelden Betty Ford Foundation. The session featured Pamela Shultz, MD, who is board-certified in internal medicine and directs courses at Betty Ford in addiction medicine for primary care physicians.
Topics included were:
- Safer prescribing practices
- Signs patients may be misusing or diverting prescriptions
- Evidence-based treatment options
- Precautionary prescribing for response to overdoses
Dr. Shultz completed a fellowship in addiction medicine at the University of Minnesota in 2008, before joining the medical staff at the Hazelden Betty Ford Foundation in Center City, Minnesota. She served as Hazelden’s medical director from 2012 through 2015, and is the course director for the organization’s recurring conference on “Addiction Medicine for the Primary Care Provider.”
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