We must deliver holistic solutions to address the opioid public health emergency

We must deliver holistic solutions to address the opioid public health emergency
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I applaud President Trump for recognizing that the opioid epidemic is a public health emergency. Our friends, families and neighbors each day are affected by the devastating toll of opioid dependence and drug overdose in our country.

The impact is saddening: 175 lives lost every day. And the trends in opioid use are going in the wrong direction — nearly 92 million Americans used prescription opioids and just 10 percent of those needing treatment for abuse are receiving it. Our nation needs to have a singularity of purpose to stop and then reverse this epidemic of addictions. 

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The President’s Commission on Combating Drug Addiction and the Opioid Crisis recently released its long-awaited report. The commission recommended 56 policy changes, all of which deserve serious consideration by our federal and state policymakers.

 

These recommendations include changes in reimbursement policies, adequate enforcement of parity laws, increased access by first responders to overdose-reversing medications, expanded access to telemedicine services, and the establishment of drug courts, among many others.

Physicians and caregivers at Ascension are committed to providing compassionate, personalized care that addresses physical pain in the context of an individual’s full health — mind, body and spirit — which includes behavioral and mental health. We are working within our communities to deliver holistic solutions for those who are struggling with addiction and to help those in recovery.

Many of our local health systems are focused on expanding services and education for both traditional and innovative therapies for addiction and other behavioral and mental health issues. Across Ascension, we have assembled dedicated teams to combat opioid dependency, including sponsoring provider and community education, standardizing pain assessment tools, and implementing pain management guidelines.

Our medical professionals also collaborate extensively with one another to promote best practices and to support each other in learning about improvements in prescribing practices and medication-assisted treatment.

For example, we’ve  partnered with the city and other community organizations to launch a pilot program, the first in the state, that places peer recovery specialists in the emergency department to help identify individuals as they overdose and help encourage and guide them through treatment and rehabilitation.

The specialists help patients toward health and recovery, and are people who have struggled with and survived addiction themselves and received special training and education.

In order to treat addiction as a disease and provide care holistically, we need to look at the root causes of addiction.

First, we must increase resources for research to learn more about addiction’s impact on the brain. 

Second, we must improve prescriber education initiatives to reduce the over-prescription of opioids while remaining sensitive to patient's’ pain. Third, we must combat the undeserved stigma that attaches to mental and behavioral illness, which may discourage early identification and treatment and reinforce secrecy to avoid society’s harsh judgment.

Fourth, and it is fortunately reflected in the commission’s recommendations, we must move from a punitive culture that shames those who are addicted to a compassionate culture that treats this vicious scourge for what it is — a disease. Lastly, it is crucial to remove policy barriers that make it harder to achieve early identification and holistic care for those suffering from addiction.

One problematic regulation, Confidentiality of Substance Use Disorder Patient Records (42 CFR) part 2, is a well-intended rule that emerged out of the enormous stigma that attaches to addiction. Under certain circumstances the regulation can be counter-productive in its application.

Privacy rules required by 42 CFR part 2 differ from privacy requirements of the Health Insurance Portability and Accountability Act (HIPAA), and this difference impedes the very care thought to most benefit addicted patients, “integrated care” models that emphasize needed data sharing and coordinated care.

In order to operationalize the requirements of 42 CFR part 2, many organizations have had to create two different electronic health records, stratifying care and hindering the early identification and treatment of addiction. For that reason, we support modifications in 42 CFR part 2 to align its requirements with those of HIPAA, thus removing one regulatory barrier.

Some of our nation’s most vulnerable people are those afflicted with addictions — and they need our help. The president and his commission have made thoughtful recommendations and stimulated much needed debate on policies to address this public health emergency. We must be quick and resolute in working together to address this important issue affecting so many Americans. People’s lives depend upon it. 

Patricia A. Maryland, Dr.PH, is president and chief executive officer of Ascension Healthcare and executive vice president of Ascension, the nation’s largest non-profit and world’s largest Catholic health system.