Announcer:
You’re listening to Perspectives with the AMA on ReachMD, produced in partnership with the American Medical Association.Here’s your host, Dr. Charles Turck.
Dr. Turck:
The opioid epidemic has expanded its deadly reach so far that it's now being called the drug overdose epidemic due to the rise in deaths caused by illicitly manufactured Fentanyl, methamphetamine, cocaine, and heroin. In response, organizations like the American Medical Association and Manatt Health have come together to end this epidemic and today, we will be taking a look at how they plan to take on such a big and critical task. Welcome to Perspectives with the AMA on ReachMD. I'm Dr. Charles Turck, and joining me today is Dr. Patrice Harris, a psychiatrist and chair of the AMA Opioid Task Force. Dr. Harris, it's great to have you with us.
Dr. Harris:
Well, it's certainly great to be with you and certainly important to amplify, this overdose epidemic.
Dr. Turck:
Great. Well - to start us off, Dr. Harris, would you give us a brief overview of what it means for the nation to be in a drug overdose epidemic?
Dr. Harris:
So, certainly pre-COVID, the United States was experiencing an increase in overdoses and overdose deaths, due to prescription opioids. But over the last several years, we've seen this epidemic evolve, and now we are seeing increased mortality-related, certainly, to illicitly manufactured Fentanyl and other opioid analogs, but also, now to methamphetamine and cocaine. And that's why we are specifically talking about the overdose epidemic because it's important to broaden our thinking from just opioids to all other substances because that again will broaden the necessary policy actions that are needed to address this epidemic.
Dr. Turck:
Thanks so much for that Dr. Harris. And now that we have that background, let's look at the 2020 recommendations from the AMA Manatt National Policy Roadmap. Would you sum up for our audience a few of the key policies that were implemented by regulators and other key policymakers?
Dr. Harris:
Absolutely. And the American Medical Association first partnered with Manatt Health, to deliver our first policy roadmap in September of 2019, and the purpose of that is really to guide policymakers in taking action. Often as I've traveled over the last several years as chair of the AMA's Opioid Task Force, policymakers, stakeholders were interested in action. They often ask what, should we be doing. And so the AMA and Manatt Health partnered and stepped in to answer those questions and so now we have expanded, that road map for 2020. It starts with our 2019 policy recommendations but now, we are laying out some new recommendations. And those are - and some of them are similar, they are unchanged and that's because we haven't made the progress that we needed to make, but increased access to evidence-based treatments to help patients with substance use disorder. We need to be laser-focused on enforcing mental health, parity, making sure those who have mental health and substance use disorders are treated equitably by insurers., We want to ensure access to physicians who are trained in addiction medicine, improve access to multidisciplinary pain care - we can't forget pain as we talk about, the overdose epidemic. We want to expand harm reduction efforts to reduce death and disease and, finally, we want to make sure that monitoring and evaluation is a part of this process. I've long lived by the maxim to inspect what you expect and we haven't always reviewed and evaluated the outcomes as relates to patients regarding policy intervention. So, we need to make a commitment to doing that monitoring and evaluation.
Dr. Turck:
And where would you say additional progress is needed at the state level?
Dr. Harris:
Well, I think there are a lot of opportunities. First and foremost, we need our state, insurance, commissioners along with all of the other relevant stakeholders to enforce parity laws. You know, parity laws at the federal level and some states have their own state parity laws, have been on the books for ten years. But we found, in our partnership with Manatt Health, that often times there was not a review - a state level review of whether or not, commercial insurers were, compliant with those parity laws. We also, know that states can and have, implemented best practices to eliminate barriers, to those who desire and require, treatment for a substance use disorder. We still, have prior authorization. We still have failed first, policies. And so, it remains difficult - I mean the barriers are thrown up, between, a person, a patient, and their ability to get care. So those are certainly, some opportunities for states. They have to be willing to use their oversight and enforcement authority.
Dr. Turck:
For those just tuning in, you’re listening to Perspectives with the AMA on ReachMD. I'm Dr. Charles Turck and joining me is Dr. Patrice Harris from the AMA to talk about the 2020 National Policy Roadmap. So, Dr. Harris, now that we've talked about some of the policy-driven efforts that have been made since 2019 to try and end the drug overdose epidemic, let's shift our focus to consider current recommendations. The 2020 Roadmap focuses on actions still needed. Would you spend a few minutes discussing where policymakers still need to take action?
Dr. Harris:
Well, I think, one area that we definitely need to take action is around harm reduction efforts. You know, certainly we are in the midst of this COVID-19 pandemic, but of course, the opioid and the overdose, epidemic preceded COVID-19. But COVID-19, has brought into even further focus and clarity issues around the lack of access to treatment. Issues around the barriers to care. And we've still seen a lot of stigma and slow uptake regarding harm reduction such as needle and syringe exchange programs. But we've seen some states work towards reducing those barriers. Again, in the midst of COVID-19, relaxing regulations, for example, that required a one-to-one needle and syringe exchange, that is an area that states, should look at. I think we, again, should not, forget about the importance of enforcing the parity laws. We also need to make sure, that there are data systems in place, and we do need to continue to amplify the need to address special populations. We put a particular focus on pregnant women in this2020 Roadmap. We also put a particular emphasis on health inequities. Again, health inequities preceded COVID, but COVID-19 has brought these inequities into stark relief. And one of the things that we knew, again pre-COVID, was people, from communities of color had less access to treatment for their mental health and substance use disorders. So, these are areas, that, we need to be laser-focused on, in addition to those original recommendations from the 2019 Roadmap.
Dr. Turck:
Well, speaking of the pandemic, if we were to zero in on our, current climate for just a few moments, Dr. Harris, what new challenges has the pandemic created in relation to your efforts to end the drug overdose epidemic?
Dr. Harris:
Well certainly, and I want to, say this because we've seen, data and reports from over 40 states who say, that they have seen an increase in overdoses and overdose deaths. Now, we will need to critically review the data. We don't want to, say here and now that there's a causal relationship, but certainly we've seen a disruption in services. We've seen an increase in stress and anxiety - people lost jobs, all of these we know in typical times, can be risk factors, for increased, substance use and certainly during the time of COVID-19 these are further exacerbated. Now, on that front, we've also seen some policy innovations. We've seen, CMS take the lead on relaxing regulations around the use of, phones in seeing patients and continuing services. We've also seen some, but clearly not enough, payers who are making sure that they are paying for these, telehealth, visits and even for these phone visits. We've seen relaxation of rules regarding the amount of take-home medicine, for example, for methadone, as you know, and hopefully the audience knows that methadone, in addition to buprenorphine, are evidence-based treatment for an opioid use disorder, but there are so many regulations around arbitrary limits - around the number of pills or the number of doses that you can take home. So, these were challenges exacerbated by COVID-19, but in some instances, we saw some regulators, both at the federal and state level, come in and relax those regulations, but I can tell you, that, unfortunately, we still are seeing prior authorizations and other administrative barriers, put before patients, so that they, again, can't get the care that they need, and we know that a delay in care or worse, denial of care, could mean overdoses and, ultimately, overdose deaths.
Dr. Turck:
Now you mentioned a little bit about this before, but I wanted to loop back around, would you be able to tell us how the Expanded 2020 Roadmap addresses racial disparities and care for historically marginalized and minoritized communities?
Dr. Harris:
Well, we make specific recommendations here and, as you know, the American Medical Association called on HHS early in this pandemic, to collect data, based on race and ethnicity, in addition to, of course gender, and, of course zip code, because we need to use that data then to target interventions. So, we are calling on, all the authorities to do the same in collecting the data. Making sure they are collecting this data by race and ethnicity and zip code. Again, we want to see - say and make sure that people know it's structural, discrimination and structural, racism that is the cause, the root cause, of these social determinates of health. And so, we specifically identify that in this Roadmap and make some specific, recommendations on how to, first of all collect the data, so that then we can target our treatments to the communities, that are most, at risk and most need these services and, that, unfortunately, have had historically limited access to treatment and services.
Dr. Turck:
And finally, Dr. Harris, what next steps are needed in order to end the drug overdose epidemic in our country?
Dr. Harris:
Well, earlier I mentioned the issue of action. We know, and I've been asked this actually, you know we've long known these issues, so, why haven't, we, made more progress, and so I would say there are two overarching requests. And that is, first of all, commit to action and through this report, we've given states and other leaders a roadmap, a guide, a how-to, take action and the second is around accountability. We have to make sure that monitoring and evaluation is continuous. There are metrics established and there are specific entities, individuals, organizations held accountable, again, for parity, for making sure, that, folks are in compliance with parity regulations, making sure there's equitable access to treatment for both substance use disorder and pain care. So, those are the two overarching, recommendations, but we have a very expanded detailed report with very specific actions. It is time to act. It is beyond time to act. And so, we hope, states use our Roadmap. We would like to, say in some period of time, I realize and we all realize that there are no one size fits all quick fix solutions, but we absolutely need to see an increase, in, availability of treatment and improvement in patient outcomes and, certainly, ultimately, a decrease in overdoses and overdose deaths.
Dr. Turck:
Well, it certainly sounds like there's a lot of really great work being done, to help end the drug overdose epidemic as well as a significant effort that still needs to be made, and I hope to have the chance to speak with you again to learn more but, for now, I want to thank my guest, Dr. Patrice Harris, for joining me to share the Expanded 2020 AMA Manatt Health National Policy Roadmap recommendations. Dr. Harris, it was great having you on the program.
Dr. Harris:
My pleasure. Thank you for having me.
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The preceding program was produced in partnership with the American Medical Association. To revisit any part of this discussion and to access other episodes in this series, visit ReachMD.com/AMA. Thank you for listening. This is ReachMD. Be Part of the Knowledge.
