Report: An opioid settlement would demand new approaches to addiction

A coalition of influential policy and advocacy leaders is arguing that if a windfall settlement ensues from lawsuits against opioid manufacturers, the money should not be wasted on efforts to create more of the same in addiction education, prevention and treatment.

Perhaps the strongest words in the report released this week by the Addiction Solutions Campaign are reserved for treatment, as in this comment: “Rather than funding a broken system, we should modernize addiction treatment by integrating it into mainstream healthcare.”

The Opioid Settlement Priorities report takes a proactive approach in recommending strategies for allocating resources that are at least months away from surfacing. A potential trial in federal court in Ohio would launch the judicial proceedings next March, although states and opioid makers and distributors are being urged by the court to engage in serious settlement talks prior to then.

Mindful of the history of a tobacco settlement that saw less than one-third of the proceeds support efforts related to smoking, leaders of the Addiction Solutions Campaign decided it was necessary to get out in front of the opioid settlement issue and lay out a bold plan for change.

“This is a once in a lifetime opportunity,” Marcia Lee Taylor, chief policy officer at the Partnership for Drug-Free Kids, tells Addiction Professional. “As a field, we know what to do. The question is, will we do it? If we don't, it'll be the biggest tragedy we've ever known.”

Science-based approach

The campaign, made up of the Partnership for Drug-Free Kids, the Legal Action Center, the Center on Addiction, and Public Health Management Corporation's (PHMC's) Research & Evaluation Group, emphasizes that its recommendations are evidence-based and therefore should be largely non-controversial. “Virtually all of it comes from well-replicated, very sound science,” Thomas McLellan, founder of the Treatment Research Institute (TRI), which as of last year became part of PHMC, tells Addiction Professional.

Still, a report that argues that most of the general public rejects existing substance use treatment models and that most of the opioid settlement's treatment funding should focus on improving primary care response is bound to raise some eyebrows in the specialty treatment community.

Three-pronged response

The coalition's report divides its recommendations into three impact areas that the group says can redefine society's approach to addiction crises for today and the future:

• Creating demand for effective policies through enhanced public and professional education.

• Implementing evidence-based prevention and early intervention to reduce costlier harms later.

• Expanding access to evidence-based addiction treatment that is integrated with mainstream healthcare.

The education component states that stigma and lack of education pose the largest barriers to treatment. The coalition says that those whose social roles bring them closest to youth, including healthcare workers and parents, need accessible and factual information about the nature of substance use, misuse and addiction (and the critical differences among the three).

Among the recommendations, the report calls for public awareness campaigns focused on parents, including guidance on how to reduce risk factors and promote protective factors. It asks for stepped-up efforts to inform consumers about their rights under the parity law (the Addiction Solutions Campaign is spearheading a national effort in this area). It also calls for mandated addiction training in state-funded medical, nursing and pharmacy schools, and loan forgiveness programs to encourage medical professionals to enter addiction practice.

In the prevention area, the report states that “if a family/community is able to prevent youth from becoming addicted during their high school and college years—there could be 80% less people with addiction.” It argues that sound substance use prevention also reduces risk of other adverse youth outcomes, and says separate prevention programming for all of these areas is not needed and could even be counterproductive.

Among the recommendations in prevention and early intervention, the report suggests reducing youths' access to substances through advertising restrictions and higher taxes on alcohol, tobacco and marijuana products. It also calls for establishment of state screening and brief intervention programs, with a particular focus on pediatric and school healthcare settings.

The treatment section of the report states that while the current addiction treatment system was legitimately designed as a separate entity in the face of a once unaccommodating health care system for addicts, the separation now creates problems, in that it addresses only the most severely ill and does not benefit from the innovation that is occurring in the rest of healthcare.

The report states that “the remarkable advances in curing and managing other diseases spurred by medical education, pharmaceutical research and the consumer movement simply did not occur in the segregated addiction treatment system. Unfortunately, one thing is certain—adding more funding to perpetuate existing, conceptually antiquated and culturally segregated prevention and treatment policies and practices simply will not work.”

McLellan adds that he knows of no specialty treatment provider who is happy with the way things are. “Most want to do broad, comprehensive care,” he says, but are stymied by excessive and misguided regulation. He wonders how the public would accept, for example, a diabetes treatment system where patients had to go to multiple providers for all of the different components of treatment, as patients with substance use disorders typically do.

The report suggests that while specialty programs still must have a role in assisting the most severely ill patients, opioid settlement funds could be used to train primary care physicians and staff in patient-centered medical homes to oversee addiction care that is integrated with the rest of healthcare.

Other treatment-focused recommendations include increasing the availability of medication-assisted treatment for opioid addiction (the report calls MAT “the most effective means of treating opioid use disorders and preventing opioid overdose”); establishing state benchmarks for quality treatment and tying provider reimbursement to them; and basing Medicaid and block grant payment levels on the extent to which organizations promote non-fragmented care.

McLellan and Taylor emphasize that the solutions to the opioid crisis and future challenges are there for the taking, if the will to embrace what works exists.

“It's not like Ebola, not like poverty,” McLellan says of the addiction problem.