By Alison Knopf
A report out from the American Medical Association (AMA) this summer recommends closing the treatment gap to address the opioid epidemic. Buprenorphine was the main treatment focus. Noting that more than 66,000 physicians and other health care professionals now have a waiver to prescribe buprenorphine in-office for the treatment of opioid use disorder, the AMA said that additional work is required to remove stigma and reduce barriers to treatment.
Methadone is not mentioned per se in the report.
Prior Authorization
Removing prior authorization requirements for medication-assisted treatment (MAT) was a key recommendation, with the report commending the states that have done so, saying “Who’s Next?”
“We are at a crossroads in our nation’s efforts to end the opioid epidemic. It is time to end delays and barriers to medication-assisted treatment (MAT)—evidence-based care proven to save lives; time for payers, PBMs and pharmacy chains to reevaluate and revise policies that restrict opioid therapy to patients based on arbitrary thresholds; and time to commit to helping all patients access evidence-based care for pain and substance use disorders,” said Patrice A. Harris, MD, chair of the AMA Opioid Task Force and current president of the AMA. A psychiatrist, Dr. Harris added: “Physicians must continue to demonstrate leadership, but unless and until these actions occur, the progress we are making will not stop patients from dying.”
Recommendations
Here are the AMA’s recommendations:
- Remove inappropriate administrative burdens or barriers that delay or deny care for FDA-approved medications used as part of medication-assisted treatment (MAT) for opioid use disorder (OUD).
- Support assessment, referral, and treatment for co-occurring mental disorders as well as enforce meaningful oversight and enforcement of state and federal mental health and substance use disorder parity laws.
- Remove administrative and other barriers to comprehensive, multimodal, multidisciplinary pain care and rehabilitation programs.
- Support maternal and child health by increasing access to evidence-based treatment, preserving families, and ensuring that policies are non-punitive.
- Support reforms in the civil and criminal justice system that help ensure access to high-quality, evidence-based care for opioid use disorder, including MAT.
Between the Lines: Methadone and OTPs Are Important
If you read between the lines, you can see the importance of methadone and opioid treatment programs, as methadone—along with naltrexone and buprenorphine—is included in MAT for OUD. And remember that OTPs can dispense buprenorphine as well—and preserve confidentiality, because a 2011 Dear Colleague letter from the Substance Abuse and Mental Health Services Administration tells OTPs to check the Prescription Drug Monitoring Program, but not to put prescribing information about their patients into it (https://atforum.com/documents/dearColl-pmp2011.pdf). This has made OTPs the last bastion of confidentiality in the substance use disorder treatment field.
That said, the AMA, which supported 42 CFR Part 2 in lobbying efforts last year, has reversed itself, allowing the organization to support weakening it in a vote by the House of Delegates this spring.
For the American Medical Association Opioid Task Force 2019 Progress Report, go to: