Despite hard-fought progress in recent years, new data from the Centers for Disease Control and Prevention show that drug overdose deaths in the U.S. are now at their highest level ever, soaring to more than 81,000 in the 12-month period between June 2019 and June 2020. At the same time, unprecedented challenges during the Covid-19 pandemic have illuminated existing weaknesses in our health care infrastructure when it comes to preventing and treating addiction.
While past presidents and members of Congress have enacted a series of bipartisan bills with important provisions that contributed to a temporary national dip in the overdose death rate, policymakers must now take action to address the remaining structural and financial roadblocks that hinder widespread addiction education and training, access to lifesaving medications, and health insurance coverage for evidence-based addiction care.
Strengthen the medical workforce to treat addiction and save lives
One of the biggest barriers to accessing evidence-based addiction treatment in the U.S. is a widespread lack of education and training in addiction medicine. Too few clinicians know how to identify and treat patients with addiction. Only 1 in 4 health care professionals receive training about addiction during medical education, according to a recent survey by Shatterproof, which also shows that a shocking number of physicians believe — incorrectly — that opioid use disorder cannot be treated at all.
There is also a nationwide shortage of clinicians who specialize in addiction medicine. The Office of National Drug Control Policy says that only about 5,000 medical doctors have addiction medicine or addiction psychiatry credentials.
With more than 20 million Americans living with substance use disorder (SUD), and an overdose epidemic exploding to record levels, much more must be done train clinicians in addiction medicine and give them incentives to practice it.
One good starting point is immediately enacting legislation to ensure that clinicians who prescribe controlled medications of any kind — not just those for addiction — receive baseline education about treating patients with SUD through health care professional schools, residency programs, or continuing education.
Another would be expanding federal programs such as the Loan Repayment Program for SUD Treatment Workforce authorized under the SUPPORT Act, the Mental Health and Substance Use Disorder Workforce Training Demonstration program, and the Practitioner Education program. These programs would bolster the medical workforce and provide the nation with an enormous return on its investment.
Remove frustrating barriers to evidence-based addiction treatment
In addition to training frontline medical workers, the nation must build its capacity and its willingness to deliver evidence-based addiction care. While therapies must be individualized to each patient’s unique needs, treatment practices should be consistent with generally accepted standards of care. The current lack of standardization in addiction treatment, on the one hand, and in health insurance coverage for it, on the other, has made it incredibly difficult for policymakers, payers, patients, and families to identify addiction treatment backed by science and evidence.
High-quality addiction care is driven by thorough assessment of an individual’s medical, psychiatric, social, and addiction factors. This assessment then leads to a patient-specific treatment plan that delineates a sufficient intensity and duration of care to produce the best possible outcome. Addiction care should be measured in months or years, not in days or weeks.
Yet even where high-quality addiction treatment services that are consistent with nationally recognized standards of care and clinical practice, such as the ASAM Criteria, are available, third-party payer policies that limit coverage or payments can prevent patients from accessing those services.
Narrow networks, onerous utilization management policies, limitations on Medicaid coverage for incarcerated individuals, and high cost-sharing requirements are just some of the hurdles that Americans face when attempting to access addiction treatment. Reforming current payment policies and ensuring mental health and addiction parity would dramatically expand access to life-saving treatments.
Finally, it is still too difficult for people with opioid use disorder to find clinicians and treatment programs providing FDA-approved medications for their disorder due to stigma and overregulation. Medications including buprenorphine, methadone, and intramuscular naltrexone should be available to all patients, no matter where they seek treatment. To accomplish that, laws and regulations that impose unnecessary restrictions on these medicines must be reformed, including eliminating buprenorphine-specific training requirements and patient limits. Otherwise, future federal investments will continue to be limited in their ability to save lives.
As Congress works with the Biden administration to address Covid-19, prioritizing the U.S.’s national response to the other ongoing epidemic of drug overdoses will be essential. This will require strengthening the medical workforce to prevent and treat addiction and removing the barriers Americans face every day when trying to access evidence-based addiction care.
Only if we are willing to take these actions will we begin to stem the tide of overdose deaths that have cut short so many promising lives and devastated a nation.
Paul H. Earley is an addiction medicine physician who specializes in the assessment and treatment of health care professionals, and currently serves as president of the American Society of Addiction Medicine.