- Improving preventive care, increasing patient access to care, and addressing societal stigma will be the linchpins in addressing the opioid crisis that ravages the nation, according to a new report from the Surgeon General.
The report, Spotlight on Opioids, looks at the national public health crisis that led to 115 opioid-related deaths on any given day during 2016 and that is costing the healthcare industry $504 billion annually. As medical experts and policymakers work to combat this issue, they will focus on a small set of key points grounded in efforts to expand treatment access.
“HHS is tackling this crisis through our comprehensive five-point strategy focused on improving access to prevention, treatment, and recovery services; promoting use of overdose reversing drugs; strengthening our understanding of the epidemic through better public health surveillance; providing support for cutting-edge research on pain and addiction; and advancing better practices for pain management,” said HHS Secretary Alex Azar in the report’s introduction.
Specifically, HHS, the Substance Abuse and Mental Health Services Administration (SAMHSA), and the Office of the Surgeon General are focusing on improving preventive services, access to treatment including medication-assisted treatment (MAT), and better care coordination during treatment and recovery.
Preventive services need to begin in the primary care office, the report asserted. Prevention must begin early in life and look for risk factors such as adverse childhood experiences, presence of mental illness, and other comorbidities that can influence substance misuse disorder.
Additionally, preventive care can include more judicious opioid prescribing, patient education, and use of alternative pain management drugs, although the report is clear that patients who truly need opioid pain medication should have access to it.
These screenings are few and far between, the report explained. Few primary care providers use substance misuse disorder screenings, and often miss other risk factors that could predict substance misuse.
Treatment for substance misuse disorder is also left wanting, the report noted. Currently, only about 28 percent of patients with a substance misuse disorder related to illicit drug use are accessing specialized treatment; when looking at all adult patients with substance misuse disorders, that proportion increases to 12 percent.
And although about 45 percent of patients with substance misuse disorder also have some type of mental illness, only 51 percent see a specialist for treatment.
Treatment options must be more readily available, the report contended. Specifically, patient access to MAT will be essential in effectively addressing opioid and other substance misuse disorders, according to Elinore F. McCance-Katz, MD, PhD, the assistant secretary for mental health and substance abuse at SAMHSA.
“Medication-assisted treatment (MAT) combined with psychosocial therapies and community-based recovery supports is the gold standard for treating opioid addiction,” McCance-Katz said in the report. “There is strong scientific evidence that this combination of therapeutic interventions is life-saving and can enable people to recover to healthy lives.”
Additionally, use of telehealth could fill in care gaps for patients who live in rural areas with scant access to substance misuse specialists.
However, there are numerous barriers to patient care access, the report contended, not least of which include social stigma.
“For far too long, too many in our country have viewed addiction as a moral failing rather than a disease,” the report explained. “This stigma has made people with substance use disorders less likely to seek help.”
It can also keep medical professionals and policymakers from creating enough patient access to these treatments, the report remarked.
Other access barriers include inability to pay for specialized treatment, lack of screening for substance misuse disorder, and lack of support or motivation to seek treatment
“Integrating substance use disorder services, as well as screening for early risk factors for substance use disorders, into mainstream health care and ensuring all Americans have access to those services has the power to substantially improve outcomes for individuals and reverse the opioid crisis,” the report asserted.
Other challenges persist: specialists for substance misuse disorder are unprepared for an influx of patients and care coordination needs; primary care isn’t prepared to administer MAT; the industry does not have sufficient enough providers amidst the provider shortage; and patient privacy and confidentiality hinder efforts to identify at-risk patients.
Essential to overcoming all of these barriers will be, again, addressing the social stigma that impacts patients’ and providers’ abilities to engage with opioid and substance misuse treatment, said Surgeon General Jerome M. Adams, MD, MPH.
“Unfortunately, stigma has prevented many sufferers and their families from speaking about their struggles and from seeking help,” he said in the report. “The way we as a society view and address opioid use disorder must change—individual lives and the health of our nation depend on it.”
It will be important for all healthcare stakeholders across the community to work together to address the opioid crisis, Adams added.
“Through partnerships, we can address the overall health inequities and determinants of health that exist where we live, learn, work, and play,” he explained. “Together we can reduce the risks of opioid misuse, opioid use disorder, and related health consequences such as overdose and infectious disease transmission.”
This shared duty will help break down stigma-related barriers to care, help promote early risk factor detection, and coordinate care and access across different avenues, the report stated.
“The responsibility of addressing opioid misuse and opioid use disorders does not fall on one sector alone, and the health care system cannot address all of the major determinants of health related to substance misuse without the help of the wider community,” the report concluded. “Everyone has a role to play in changing the conversation around addiction, to improve the health, safety, and well-being of individuals and communities across our nation.”