Column: There’s more to do on opioids
Over three years ago, I co-authored an article with recommendations on how Michigan should tackle the opioid epidemic. Chief among these recommendations include physicians limiting the number of opioids prescribed to patients and for physicians to utilize prescription drug monitoring systems with state governments ensuring ease of use. Despite the constant stream of news items on opioid addiction and deaths, Michigan has taken several steps in line with these recommendations:
■In April 2017, Michigan’s prescription drug monitoring system, Michigan Automated Prescription System (MAPS), was markedly improved with faster results and analytics
■New legislation regarding physician prescription practices was signed into law late last year, including limiting the amount of opioids a physician can prescribe at a single encounter and mandating physicians utilize MAPS when prescribing prescription pain medications.
While there is some grousing in the physician community (this doctor included) about legislating parts of the physician-patient relationship, everyone should applaud the state’s leadership in attempting to tackle this epidemic. My response: It’s a start, but a lot more needs to be done.
These laws still do not fully address prevention and treatment. The following recommendations will address several gaps:
■ Promoting non-pharmacologic therapies for pain: There is increasing data pointing to the benefit of non-pharmacologic remedies for pain including acupuncture, massage, and cognitive-behavioral therapy.
Recently, the Joint Commission on Accreditation of Healthcare Organizations rolled out new pain assessment and management standards for hospitals, including the need to offer non-pharmacologic therapy options for pain. As pointed out by the President’s Commission on Combating Drug Addiction and the Opioid Crisis, several of these non-pharmacologic treatments are not reimbursed in the same way as opioids or other pain medications are. Physicians and patients will face limiting prescription pain medications but offering other modalities that may lead to patients paying more. While CMS will undoubtedly change the way these treatments are covered, states, including Michigan, should mandate that insurance payers provide coverage for these treatments.
■ Expanding Medication Assisted Therapy: When most people think about treatment for drug addiction, their thoughts turn to rehabilitation centers where abstinence may be the main route of treatment. Medication Assisted Therapy (MAT), a treatment involving medications that fight the cravings recovering addicts fall prey to, has been offered for years and is very successful. While normally administered by behavioral health specialists, MAT can be performed in the primary care setting and a recent study by physicians from the University of Michigan has validated its success.
Michigan needs to expand MAT for patients suffering from opiate addiction. Michigan lacks enough behavioral health specialists, and the amount of resources required for MAT are unavailable in most primary care physician offices. But both private and public insurance payers need to work with physicians in order to provide adequate resources to administer this proven treatment particularly in rural and underserved areas.
■ Leveraging integration between behavioral and physical medicine: There has been a great deal of media coverage regarding integration pilots between Michigan Community Mental Health Services and the State’s Medicaid HMOs. The hope is that the pilots will promote quality and lower costs while treating this vulnerable population. And while the specifics are lacking on how this integration will be accomplished, it offers a great opportunity to break down significant silos, particularly when it comes to substance abuse.
Emergency physicians are well aware of patients suffering from concomitant substance abuse and mental health conditions who, without a place to go, eventually end up in local Emergency Rooms. The opportunity exists for the Community Mental Health Services to utilize the data and care coordination that Medicaid HMOs can provide to track prescription drug utilization, offer treatments with a multidisciplinary team, and, most importantly, prevent patients from being lost between the behavioral and physical medicine space. If these pilots are successful, they should be rapidly expanded. These changes would make a significant impact in the lives of our fellow citizens.
Dr. Vik Reddy is a plastic surgeon and chief clinical integration and quality officer at Henry Ford Macomb Hospital, and associate medical director of population health with Henry Ford Health System.