- The healthcare industry must collaborate with the broader public health community to take a population health management approach to combating opioid misuse and substance abuse, states the American College of Physicians (ACP) in a new position paper.
As the opioid epidemic continues to shatter lives, ratchet up spending, and complicate the chronic disease management process, providers should try to employ preventive, patient-centered care strategies, enhanced screenings, and more comprehensive follow-up to ensure that vulnerable patients receive the help they need.
“Substance use disorders pose a heavy societal burden, endangering individual and family health and well-being, tearing through communities, and sapping resources from the health care system,” states the paper, published in the Annals of Internal Medicine.
“These disorders are common in the general population and occur at even higher rates among those who are incarcerated.”
While substance abuse disorders have long been classified as an American epidemic, only 18 percent of the 22.5 million individuals in need of care receive any sort of treatment.
In comparison, more than 77 percent of people with hypertension, 73 percent of diabetics, and 71 percent of patients with major depression receive care for their chronic diseases.
Population health management strategies, such as more comprehensive screenings and robust follow-up, have successfully raised the rates of chronic disease management for these other conditions, and could significantly improve the reach of substance abuse treatment, as well.
“Substance use disorders are treatable chronic medical conditions that should be addressed through expansion of evidence-based public and individual health initiatives to prevent, treat, and promote recovery,” ACP states.
Clinicians should become more familiar with evidence-based guidelines for pain management, and may wish to work more closely with behavioral health specialists to identify and treat patients at high risk of developing opioid addiction or another substance abuse disorder.
“Physicians are obligated by the standards of medical ethics and professionalism to practice evidence-based, conscientious pain management that prevents illness, reduces patient risk, and promotes health,” ACP said.
“ACP strongly believes that physicians must become familiar with, and follow as appropriate, clinical guidelines related to pain management and controlled substances, such as prescription opioids, as well as non-opioid pharmacologics and non-pharmacologic interventions.”
The physician society also calls upon lawmakers to consider alternatives to incarceration or other criminal penalties for non-violent people struggling with substance abuse, and suggests that a movement towards clinical treatment and long-term rehabilitation may be a more effective approach.
Enhanced cooperation with the public health and law enforcement communities could also expand access to naloxone treatment, an effective response to opioid overdoses, and help to connect vulnerable individuals with rehabilitation resources.
In addition, the ACP advocates for the development of a national Prescription Drug Monitoring Program (PDMP), which could improve monitoring of drug seeking individuals, identify physicians with worrisome prescribing habits, and target education and resources to communities exhibiting worrying trends.
“The College strongly urges prescribers and dispensers to check PDMPs in their own and neighboring states (as permitted) before writing and filling prescriptions for medications containing controlled substances,” says the paper.
“All PDMPs should maintain strong protections to assure confidentiality and privacy,” ACP said. “Efforts should be made to facilitate the use of PDMPs, such as by linking information with electronic medical records and permitting other members of the health care team to consult PDMPs.”
In order to expand the delivery of substance abuse treatment, the College strongly recommends that policymakers focus on training qualified care coordination and behavioral healthcare staff to cope with an increased caseload.
Substance abuse training should take place “throughout the continuum of medical education” to prepare providers to identify and manage high-risk patients, and “continuing medical education providers should offer courses to train physicians in addiction medicine, medication-assisted therapy, evidence-based prescribing, and the identification and treatment of substance use disorders.”
If healthcare providers are better equipped with the skills they need to develop positive prescribing habits, identify those at risk of dependence, and effectively treat opioid abuse and other substance disorders, they may be able to reduce the devastating impact of drug misuse on American society.
“Communities across the country are confronting an opioid epidemic that has taken tens of thousands of lives, leading physicians to take a more active role in managing the condition and spurring policymakers to reassess the nation's drug control policy,” the paper concludes.
“Physicians can help guide their patients toward recovery by becoming educated about substance use disorders, proper prescribing practices, consulting prescription drug monitoring programs to reduce opioid misuse, and assisting patients in their treatment.”