“Top 12 Wish List” for Patients Reeling from the Opioid Epidemic and Facing Substance Use Disorder

1. What if community and chain pharmacists created a well-advertised campaign with prominently displayed signage in every pharmacy asking “How Am I Doing? Call this 800 number…”? If trucks everywhere can have stickers on their backsides asking “How’s My Driving? Call this 800#,” can the chain and community pharmacists give patients a readily available resource too? What if patients called this number when denied access to medication assisted treatment (MAT)? Could it be one part of a larger effort in reducing the stigma the Surgeon General mentions in his recent report? This issue came up repeatedly during the Congressional and HHS debate to raise the patient cap on MAT.

2. What if pharmacy associations installed a Zero Tolerance policy for turning away patients seeking medication assisted treatment? If PhRMA can vet and impose self-policing policies on things like direct-to-consumer advertising, can NCPA and NACDS do the same to address the stigma patients feel when getting help for their opioid addiction.

3. What if every continuing education credit earned by a pharmacist included sensitivity training on patients facing addiction and their role in supporting such patients? Or if a course on addiction, treatment options, etc., were a mandatory part of Pharmacy programs? If law schools can require an Ethics class prior to graduation, this seems easy enough to do.

4. What if every insurer let people struggling with prescription opioid dependence or opioid use disorder get evidence-based MAT early rather than require a year or more of documented struggle and failure?

5. What if every payer’s restrictions on MAT and counseling had to be justified? There is no evidence to suggest MAT or related counseling should only be provided for three, six or twelve months. There is, however, a lot of evidence to suggest that time consuming, difficult-to-understand, constantly renewing prior authorization paperwork is a barrier to prescribing.

6. What if such payer policy and restriction were highlighted in a Surgeon General’s report released to the public each month?

7. What if we listened to the jailers and sheriffs around the country spending increasing amounts of taxpayer dollars to fight smuggling and the resulting violence in facilities by banning the film versions of medication assisted treatment? Look to what Maryland is doing as a great start.

8. What if there was an up-to-date list of all available prescribers, by zip code, with room in their patient cap – doctors, nurse practitioners, and physician assistants – and a place these prescribers could call if they were at their cap.

9. What if every emergency room that saw patients rescued with naloxone were released only after making a referral to a MAT prescriber off that up-to-date list? And at least one follow up call to the patient was required of that ER?

10. What if network adequacy was defined differently for MAT, not by the standard time and distance parameters, but by MAT prescribers with space in their patient cap?

11. What if CMS’ recent proposal to adequately reimburse physicians for seeing disabled and complex chronic care patients were extended to include patients facing addiction?

12. What if CMMI considered launching a model that included these things and collected data and measured outcomes for the largest healthcare problem facing our country?

There are examples all around us of things that can be repurposed or seen through the lens of how to help get through this opioid epidemic and its consequences. And very few, if any, require costly new laws or regulations. They require common sense, coming together, to undertake several seemingly small steps that can, together, make a difference. There may yet be a silver bullet, but until it presents itself, we collectively should take some incremental steps now. 

This reflects my own personal perspectives, not those of any Connect 4 Strategies’ clients.