The American Medical Association (AMA) and Manatt Health have released, “National Roadmap on State-Level Efforts to End the Opioid Epidemic,” an analysis identifying effective state policies against the national opioid epidemic. The analysis reviewed the response to the epidemic in four states (Colorado, Mississippi, North Carolina, and Pennsylvania) and determined which policies increased access to evidence-based treatment for people with a substance use disorder in those states.
The roadmap highlights six areas where regulators, policymakers, and other stakeholders across the country can act to effectively address the epidemic:
- Improving access to evidence-based treatment for opioid use disorder by removing prior authorization and other barriers to medication-assisted treatment (MAT) for opioid use disorder—and ensuring MAT is affordable.
- Increasing oversight and enforcement of mental health and substance use disorder parity laws.
- Ensuring adequate networks that allow for timely access to addiction medicine physicians and other health care professionals; this includes payment reforms, collaborative care models, and other efforts to bolster and support the nation’s opioid use disorder treatment workforce.
- Enhancing access to comprehensive pain care, including non-opioid and non-pharmacologic options.
- Reducing harm by expanding access to naloxone, the overdose-reversing drug, and coordinating care for patients in crisis.
- Evaluating policies and outcomes to identify what is working, building on successful efforts, and identifying policies and programs that might need to be revised or rescinded.
The analysis also includes important information about potential misapplications of the Centers for Disease Control and Prevention’s (CDC) chronic pain guideline when it comes to treating people with cancer and other chronic conditions. The analysis explicitly states that, “Examples of misapplication include applying the Guideline to patients in active cancer treatment, patients experiencing acute sickle cell crises, or patients experiencing postsurgical pain.”
ASCO is pleased to see this important provision included in a roadmap to address the opioid crisis nationwide. In April 2018—following a request for clarification from ASCO, the American Society of Hematology (ASH), and the National Comprehensive Cancer Network® (NCCN)—CDC issued a key clarification letter, which noted that its chronic pain guideline was developed to provide recommendations for primary care clinicians who prescribe opioids for patients with chronic pain outside of active cancer treatment, palliative care, and end-of-life care. The letter conveys that CDC’s guideline is not intended to deny clinically appropriate opioid therapy to any patients who suffer acute or chronic pain from conditions such as cancer and sickle cell disease, but rather to ensure that physicians and patients consider all safe and effective treatment options for pain management with the goal of reducing inappropriate use.