June 17, 2020 at 5:00 am ET
Before COVID-19 turned our nation upside-down, policymakers were taking steps to help patients access evidence-based treatment for opioid use disorder. This included focusing on removing health insurers’ barriers to medication and requiring insurers to provide parity for mental illness and substance use disorders — and holding them accountable for violations of the law in Massachusetts, Pennsylvania and New Hampshire, to name a few recent examples.
While we continue to take steps to address COVID-19 to help keep the public safe, the American Medical Association has seen reports from more than 30 states concerning increases in opioid-related mortality, mental health crises, suicide and addiction-related relapse. Reports are from every region in the nation. This includes a 20 percent increase in calls to the Jacksonville, Fla., fire department concerning overdoses; an “unusual spike” in overdoses in DuPage County, Ill.; increased emergency department visits in coastal North Carolina and spikes in fentanyl-related overdoses in Seattle. Georgia, too, has not been spared, causing increased concern for many.
Social distancing, a dramatic increase in unemployment and widespread economic woes lend themselves to common substance misuse triggers: isolation and anxiety. The medical community often refers to addiction as “a disease of isolation,” and Americans are at high risk now, even those who did not misuse opioids previously. Those who are homeless or incarcerated may be particularly vulnerable. At the end of April, 28 percent of Americans reported worsening mental health, and 34 percent reported worsening emotional well-being.
As these stories continue, the AMA is working with federal agencies to help protect our communities. In particular, the U.S. Substance Abuse and Mental Health Services Administration and U.S. Drug Enforcement Administration have increased flexibility for providing buprenorphine and methadone to patients with opioid use disorder, and the DEA has also increased flexibility to help patients with pain obtain necessary medications.
Additional steps must be taken to help ensure the nation’s opioid epidemic does not become worse.
First, governors must adopt the new SAMHSA and DEA rules and guidance in full for the duration of the COVID-19 pandemic — this includes flexibility for evaluation and prescribing requirements using telemedicine. For example, Virginia’s Medicaid program has eased telemedicine requirements and now allows physician judgment for telemedicine and telephone-only consultations on opioid usage.
Second, states must remove prior authorization, step therapy and other administrative barriers for medications used to treat opioid use disorder. These barriers were dangerous before the pandemic and are even more dangerous now, as patients are having even more trouble accessing care. Seeing the need to cut this red tape during COVID-19, Rhode Island has already streamlined prior authorization requirements. Connecticut, Massachusetts, Maine, New Hampshire and Vermont also have waived certain Medicaid prior authorization requirements for patients during this emergency.
States also must remove existing barriers for patients with pain so they can obtain necessary medications. This includes removing arbitrary dose, quantity, and refill restrictions on controlled substances. For example, Texas previously extended emergency rules to help ensure chronic pain patients have continued access to necessary pain care.
Lastly, states must enact, implement and support harm-reduction strategies, including removing barriers to sterile needle and syringe services programs and increasing access to naloxone. Maine has demonstrated best practices by ending one-to-one sterile needle exchange limitations to help avoid the spread of infectious disease and other harms. New Jersey’s Harm Reduction Coalition has been taking steps to ensure patients can receive naloxone through the mail. More states should follow suit.
Recognizing the intersection of COVID-19 and the opioid epidemic, policymakers, physicians, community leaders, first responders and others must ensure enhanced collaboration now more than ever. We are asking governors and state policymakers to take on even more. At the same time, the nation’s physicians continue to demonstrate our commitment to rush toward these emergencies.
Dr. Patrice A. Harris is the immediate past president of the American Medical Association and chair of the AMA Opioid Task Force.
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