Coalitions tailor opioid policies

In California, 12 new regional coalitions are bringing together once-siloed stakeholders in order to decrease deaths cause by opioid addiction and overdose. The California Healthcare Foundation (CHCF) funded the coalitions, representing 20 counties.

Participants include medical societies, county public health agencies, health plans, medical groups, hospitals, pharmacies, law enforcement, the correctional system, community groups, and addiction treatment centers. Coalitions are looking for a holistic, community approach to decreasing addiction and death rates associated with prescription opioids.

Kelly Pfeifer, MD, director of high-value care for the California Healthcare Foundation, studied models from across the country, including New York City, which saw a 29 percent decrease in deaths from opioid overdose over two years.

“We wanted to bring medical systems and substance abuse systems to the table to coordinate care,” Pfeifer says. “In many states, doctors are abruptly stopping treatment or ‘firing’ patients who have been prescribed prescription painkillers for years. These opioid refugees, dependent on meds, have nowhere to go and often turn to street pills or heroin. Most do met the criteria for a substance abuse clinic, but they are just as much in danger of dying from an overdose.”

CHCF aims to decrease opioid-related deaths by 20 percent in the next three years by assisting coalitions with community outreach, collaborating with law enforcement and educating clinicians about the risk of overprescribing opioids. Though many health agencies and hospitals are the lead agencies, Pfeifer says that they will be looking to engage with more substance abuse treatment centers as the program begins developing goals and metrics.

“Each county and region’s approach will be different, but we believe that everyone should have access to the full range of proven treatments,” Pfeifer says.

Policy changes

She adds that CHCF will be working toward updating laws that increase data exchanges between primary care physicians, psychiatrists and treatment centers in order to decrease the chances for doctor shopping. A more user-friendly version of California’s prescription drug monitoring program (PDMP), CURES 2.0, is also being relaunched in January 2016.

 “It wasn't easy to get the information needed, but the state invested in improving the system,” Pfeifer says. “Now, doctors can very quickly identify patients at high risk: those on high doses, or those using multiple prescribers for prescription painkillers."

Twenty-seven state, specialty and healthcare associations, including the American Medical Assn. (AMA), and the American Society of Addiction Medicine, joined together in July 2015 to encourage clinicians to use state-based prescription drug monitoring programs.

“PDMPs vary greatly in efficacy and functionality from state to state," said AMA Board Chair-Elect Patrice A. Harris, MD, MA. “Alone, they will not end this crisis, but they can provide helpful clinical information, and because they are available in nearly every state, PDMPs can be effective in turning the tide to end opioid abuse in the right direction.”

Nationally, organizations are realizing that there’s no one-size-fits-all approach to decreasing opioid abuse. In September, U.S. Department of Health and Human Services Secretary Sylvia M. Burwell announced that the department will be awarding $1.8 million in grants to communities in 13 states to expand medication-assisted treatment, help patients enter treatment facilities, and clinician education for healthcare and community organizations that encounter opioid abuse.

Burwell spoke to the complexity of opioid addiction treatment, and the goal to update regulations around buprenorphine and increase the use of naloxone.

 “This epidemic is multi-faceted, and we need to respond with the best solutions that medicine and behavioral therapy can provide together,” she said during an event that convened healthcare professionals across the country. “So we need to increase the use of buprenorphine, which can help us treat opioid use disorder when combined with psycho-social support. We have heard from many stakeholders and leaders that the current capacity does not meet demand.”