Address the Opioid Crisis

Address the Opioid Crisis

As the U.S. continues to confront the opioid crisis, attention has been focused on prescribing and dispensing these drugs. Despite the risk for abuse, opioids play a legitimate role for many patients with chronic pain and cancer pain. Federal efforts to combat the abuse of opioids should not pose a barrier to access for those who truly need these drugs to treat chronic pain. Failing to do so will result in a crisis of untreated chronic pain.

Primary care physicians are on the frontlines of the opioid epidemic and have been instrumental in treating patients with substance use disorders (SUDs) and opioid use disorders (OUDs). Osteopathic family physicians support behavioral health as part of the whole-person approach to care and the use of community support resources and federal actions, including additional funding and access to medication-assisted treatment (MAT) to treat mental health and SUDs.

However, some well-intentioned efforts to improve OUD treatment may push patients away from their family physicians. Specifically, bundled payments for opioid treatment assumes there is a standardized way to treat OUD and SUD patients. Osteopathic family physicians understand that each patient is different, and as a result, they are in the best position to address individual patient needs. Because OUD patients are members of the physicians’ community, osteopathic family physicians understand the patient’s unique clinical needs and social factors that may impact substance use.

CMS must carefully consider new payment models to ensure the agency does not drive patients to non-primary care for OUD services. Currently, insurance coverage is counter to efforts to combat the opioid crisis. For example, some insurers will only cover the less-expensive (and highly addictive), short-acting opioids, but will not cover long-acting hydrocodone with abuse deterrents or alternatives, such as a buprenorphine (Butrans®) patch.[i]

In addition, ACOFP believes that reimbursement for nonopioid pain management therapies needs to be revisited and updated. There are opportunities to change routine practices and work toward addressing and treating root causes of pain through non-pharmacological interventions, such as OMT. OMT has many clinical benefits that improve patient outcomes. The clinical benefits OMT provides should be considered when determining OMT reimbursement.

Reports show that the opioid crisis worsened during the COVID-19 pandemic. The Centers for Disease Control and Prevention (CDC) estimates there were 107,622 drug overdose deaths in the U.S. during 2021, which represents an increase of nearly 15 percent from the 93,655 deaths estimated in 2020.[ii] ACOFP is concerned that some of CMS’s policies steer patients away from their family physicians in a manner that may erode sustainable improvements and undo inroads made in resolving the opioid crisis.

Advocacy Positions:

• Support federal legislative and regulatory actions that combat the opioid crisis, but do not impede access to opioids for legitimate indications and patients.
• Encourage federal action on behavioral health, including additional funding for mental health facilities and training more physicians to manage these patients.
• Support additional reimbursement for family physicians to provide high-level, in-office screening and make appropriate referrals to behavioral health specialists.
• Provide parity in reimbursement for behavioral health screening and services.
• Support greater access to MAT by loosening prescribing rules and expanding telehealth services, especially in rural areas.
• Ensure that family physicians are leading care for patients experiencing OUDs.
• Encourage CMS to reassess the appropriateness of bundling for payment of OUD services.
• Leverage existing primary care-focused codes that support family physicians’ ability to treat OUDs.
• Increase access to and knowledge of OMT as a pain management treatment option.
• Ensure OMT reimbursement is appropriate for the clinical benefit it provides.

[i] Thomas K, Ornstein C. Amid opioid crisis, insurers restrict pricey, less addictive painkillers. The New York Times. September 17, 2017. Accessed January 12, 2023. https://www.nytimes.com/2017/09/17/health/opioid-painkillers-insurance-companies.html

[ii] U.S. Overdose Deaths in 2021 Increased Half as Much as in 2020 – But are Still Up 15%. News release. Centers for Disease Control and Prevention; May 11, 2022. Accessed January 12, 2023. https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2022/202205.htm