President mandates opioid training for prescribers

President Obama sent a memo today to several federal agencies giving them new marching orders related to the opioid addiction crisis in the United States. Specifically, the memo calls for two actions:

1. All federal healthcare workers and significant government-contracted healthcare professionals must complete training on evidence-based, appropriate prescribing of opioids within 18 months and then refresh their training every three years. The White House hopes the federal effort will “be a model for similar initiatives developed across the country.”

2. Agencies must submit an action plan to the White House to address barriers to medication-assisted treatment (MAT) within 90 days.

Kelly Clark, ASAM president-elect, says the move seems like a step in the right direction for providers because most of them receive very little training on addiction medicine in their residency or medical school education programs.

“ASAM does support increased training for the use of opioids,” Clark tells Behavioral Healthcare. “We’d like to see stronger emphasis on training for diagnosing and knowing what evidence-based treatment is for opiate addiction.”

The new federal training, according to the White House memo, must address best practices for appropriate prescribing of pain medications; principles of pain management; the misuse potential of controlled substances; identification of potential substance use disorders and referral to further evaluation and treatment; and proper methods for disposing of controlled substances. Any training adopted by the agencies must be consistent with consensus guidelines on pain medication prescribing developed by the Centers for Disease Control and Prevention (CDC).

Clark says CDC is currently working on some new guidelines around chronic pain treatment, but the guidelines aren’t available yet.

“The president’s recommendations today on prescriber education and MAT set the stage for federally funded healthcare providers to exemplify how providers everywhere can take the steps necessary to ensure that all Americans have access to quality, evidence-based addictions treatment,” says Becky Vaughn, vice president of addictions for the National Council for Behavioral Health. “These proposals will be a major help to increase prevention, treatment and recovery efforts, and we hope it doesn’t take the full two years for this critical training to occur.”

MAT barriers

Last month, the federal Department of Health and Human Services vowed that it would revise the limitations for prescribers of MAT, who currently can only treat 30 patients at a time, or apply for an extension to treat 100 patients maximum. It’s one of several new federal efforts focused on increasing access to MAT.

Clark says the prescriber limits are just one of the barriers. She anticipates the forthcoming reports also will highlight the administrative barriers, such as cumbersome prior authorization processes and fail-first requirements.

“There are a number of states where there’s a lifetime limit on MAT, a forced maximum dose, or patients have to follow random decreases in dosage,” she says. “We would never allow this in any other disease state.”

The access issues are prevalent in commercial healthcare coverage plans as well as Medicaid, according to ASAM research.

“There’s the barrier of stigma and the barrier that some providers fail to see addiction as an ongoing primary brain disease,” Clark says.

In a call announcing the White House actions today, Michael Botticelli, director of the White House Office of National Drug Control Policy, said there is a sense of urgency at the federal level to do more to address the opioid addiction issue and to create “unfettered access” to MAT. One goal is to double the number of providers who can prescribe the three FDA-approved medications used in MAT over the next two years. Currently 30,000 professionals are waivered to prescribe.

“We will promote multiple pathways to recovery but make sure that people have access to these services,” he said.