Despite early challenges in scaling diagnostic testing for Covid-19 and a halting start to the vaccine rollout, the U.S.’s rapid response to the pandemic has highlighted the importance of coordination between the government, private business, and citizen mobilization. Those efforts, orchestrated in part by Operation Warp Speed, delivered multiple effective vaccines in an unprecedented time frame.
But even as the country rightfully focused on the pandemic, a record number of individuals in the U.S. have died from drug overdoses. Adults between the ages of 25 and 44 years have been more than twice as likely to die from opioid overdose than from Covid-19, yet no coordinated effort in the mold of an Operation Warp Speed exists to stop this epidemic.
As nationwide vaccination programs help nudge the U.S toward the recovery phase of the Covid-19 pandemic, industry leaders and legislators should use the lessons learned from the public-private coalitions forged in Operation Warp Speed to solve the decades-long overdose epidemic. Several actions that mirror steps taken during the Covid-19 pandemic could significantly improve the country’s response to overdose deaths.
Eliminate government barriers to opioid addiction treatment
A lack of clear and consistent messaging from federal and state governments at the start of the pandemic was a catastrophic mistake that hampered the country’s response.
To provide a clear road map on overdose deaths, the Biden administration must eliminate contradictory messaging on prescription medications for addiction that have been shown to reduce deaths from opioid overdose by approximately 50%. On one side, the federal Substance Abuse and Mental Health Services Administration has encouraged prescription of FDA-approved medications for opioid use disorder. On the other side, the Drug Enforcement Administration has increased surveillance activities that discourage potential prescribers for these medications. This contradictory messaging has confused ordinary citizens, clinicians, and even pharmacists, who frequently refuse to fill legitimate prescriptions for these medications, further reducing access to treatment that is already constrained.
The Biden administration’s announcement on Tuesday to lift some barriers to prescribing buprenorphine to treat opioid use disorder was a step in the right direction. Yet many barriers still remain to making this form of treatment mainstream and accessible to those who need it most. The new guidelines still limit prescribers to treating just 30 patients at a time with buprenorphine. Ironically, no such restrictions exist on prescribing the opioid pain medications that have fueled the epidemic.
Many providers are reluctant to prescribe buprenorphine. One 2016 study showed that 53% of rural providers with a 30-patient DEA waiver were not treating any patients with buprenorphine. These findings suggest that the recent guideline modifications may not be a panacea for the opioid epidemic, and more changes will need to be considered. The Biden administration should signal its support for the bipartisan Mainstreaming Addiction Treatment Act to lift the remaining restrictions on buprenorphine and expand access to this lifesaving medication.
Telemedicine became an essential tool for health care providers during the pandemic. For many people with addictions, telehealth became the only way to access care, as most treatment providers were forced to close their doors to in-person care. Congress should pass a recently introduced bipartisan bill that will allow health care providers to continue using telemedicine to prescribe medications for opioid use disorder. The Comprehensive Addiction and Recovery Act 3.0 would help create a permanent regulatory pathway for prescribing buprenorphine and other medicines for treating addition via telemedicine — a proven modality for expanding access to care.
Expand insurance coverage and address social determinants
Under government mandate, public and private insurers uniformly offered coverage for Covid-19 diagnostic testing and vaccinations during the pandemic. Compare that with the variability in coverage for addiction treatment that has mitigated the quality of care for people with opioid addictions for years.
Facilities across the country regularly — and illegally — deny admission to patients with addictions. In some states, clinicians are encouraged to terminate outpatient treatment after a patient being treated for a substance use disorder has three positive drug tests — a shortsighted policy that completely misunderstands the chronic nature of addiction and the deadly, costly consequences of being expelled from treatment.
Many state Medicaid authorities have prohibitive prior-authorization requirements that restrict access to adequate care. More broadly, Medicaid reimbursement rates are often so low that they inhibit private-sector interest in providing care for Medicaid patients, who constitute the majority of individuals seeking treatment for addictions.
One possible policy solution to this vexing interstate variability could come from the new comprehensive outpatient opioid addiction treatment bundle. It was enacted under the 2020 Medicare physician fee schedule and provides sustainable reimbursement for providers who treat patients with substance use disorders holistically and in a coordinated fashion. Extending these Medicare bundle codes to all state Medicaid plans could provide immediate standardization of reimbursement rates across states and provide a much-needed incentive for quality of outpatient addiction care in the Medicaid space.
Despite the clear need for further government action, some progress has been made toward standardizing access to care for addictions. CMS expanded Medicaid coverage for the treatment of opioid use disorder at the end of 2020. The Biden administration has also proposed government spending to combat the underlying corrosive and costly societal problems that are strong drivers of addiction, such as income inequality, housing insecurity, underemployment, and social isolation, and we encourage continued investment in this area for communities that are most impacted by opioid addiction.
The national opioid epidemic has worsened since the outbreak of the Covid-19 pandemic for reasons that could be corrected with a policy approach similar to what was deployed against the Covid-19 pandemic. We urge the Biden administration to learn from its Covid-19 successes and prioritize a bold, coordinated agenda against opioids, which have been killing Americans by the thousands for decades — most of them in the primes of their lives.
We need an Operation Warp Speed for the opioid epidemic to reverse this tragedy.
Thomas McLellan is the founder of the Treatment Research Institute, an independent, nonprofit organization focused on science-driven reform of substance use treatment and policy, and former deputy director of the White House Office of National Drug Control Policy during the Obama administration. Jacob Crothers is an addiction medicine physician and chief medical officer of Groups Recover Together, a national health care company for individuals with opioid use disorder.
A serious issue that HAS TO come to the forefront of this topic is that of separating substance abusers from chronic or Intractable pain patients. Pain patients, doctors, and pharmacists NEED TO BE left alone by the dea; the agency should concentrate on slowing the flow of illicit manufactured fentanyl (IMF), which is what is killing drug abusers in this day and age (NOT prescription medications anymore). Pain patients need to have the ability to obtain relief by having prescription analgesics re-introduced into their treatment plans. Many studies show that pain patients RARELY develop the disease of Addiction (physical dependence is something else altogether), often guard or lock up their meds which eliminates diversion, and do not experience any euphoria from using prescription meds. Drug abusers, on the other hand, are LOOKING for that euphoria to escape from whatever their demons are. Biden Admin should look at ending the dismally-failed “War on Drugs” and decriminalize all drugs, taking away the intensely felt they’ll of doing something illegal. It also would be a form of harm reduction, and a big boost to the country’s tax system if the guvmint were to be the regulators of purity, placed limits on the amount to be purchased in one time frame, and regulated supply and demand and taxes. Then, IF people were to use the drugs, they know they would not be getting adulterated and cut drugs. Perhaps do a story on the plight and suffering that Chronic and/or Intractable Pain Patients are experiencing. There is a going list of all of the suicides caused by having lost access to these life enhancing medications. (The cdc winners why there’s an increase in suicides; maybe they should take a good look at what has become from legislators jumping in the Guidelines band-wagon that they created).
Thomas McLellan aren’t you on the board of Indivior the pharma company that makes Suboxone and was fined 1.5billion with a B for deceptive marketing, with plans to expand their market with other products to profit off this ILLEGAL street drug problem. You would benefit directly from this. Also, you’re on the board of an an addition advocacy group Shatterproof that pushes the most anti-patient ideology, as if no one gets incurable painful diseases, cancer, has horrifying accidents, war injuries, or reaches a painful end of life.
This policy is completely ludicrous! People in legitimate pain are suffering because of ILLEGAL drug overdoses. People in ACUTE pain are suffering as well. My sister had a double mastectomy and they gave her 3 days of barely any pain meds, 5 mg Vicodin’s 5xs a day? For having 2 parts of her body chopped off? And then to be forced to be in pain after suffering through cancer and a double mastectomy, not to mention the mental stress of being in pain and not being able to take care of yourself. Also no home health care either. She said it was excruciating just to lift her pinky finger!
My son had to have surgery to repair a severely broken collarbone, which is one of the hardest surgeries on an orthopedic patient. They were bruises shaped like a footprint when he came out of surgery, he has never, not once taken a prescription pain pill in his life and yet he was also treated like a drug addict by the doctors AND the pharmacist who now give out their own biased opinions to ANYONE who takes an opioid! He was given a single day of pain medication and missed almost a month of work because the same physician said he couldn’t go back to work because of the pain he was in!
I have a deteriorating condition in my spine that caused extreme pain and will land me in a wheelchair before it’s done and they cut my prescription so drastically FMLA won’t even cover the time I need off because I cannot get out of bed in the morning. Literally. No home healthcare and I live by myself. My joints lock up overnight where I cannot bend hip or knee, yet I can only receive enough pain meds to barely touch the pain all because of ILLEGAL use and obtaining of illegal fentanyl and a few pill mills which we ALL want closed so that people in legitimate pain can receive the care they need. I have never taken more than prescribed and let me tell you, it’s like being on fire and there’s a bottle of water sitting next to you but you can only use a tiny sip to put the fire out and sit there and burn for the next 4 hours making me FEEL like an addict when in reality, I get zero pleasure or “high” from the roxicodone I take because all it does is LESSEN the pain so I can function normally. I am now forced to live with extreme pain , about an 8 out of 10 on the pain scale on a daily basis! I have done everything right and yet I am labeled an addict for not wanting to be in pain all the time? Why? Why am I and others like me being punished because people are illegally obtaining fentanyl, which I have never even tried? It took my doctor and I around 3 years to get the dose right along with physical therapy, steroid injections and other medications. Have mris annually. I have done EVERYTHING according to my DOCTORS plan and he is NOT a pill pusher. He is also being treated like he’s a drug dealer and is terrified to do his job because of the threat of also being mislabeled and losing his practice. I’ve had multiple pharmacies refuse to fill my prescriptions which they loudly announced to everyone in the store. Which should be illegal as it is straight up discrimination against pain patients!
I also went to a pain support group that had 10 active members. We talked a lot amongst ourselves even outside of the group. 5 of them were in so much pain their entire day was filled with nothing but excruciating pain, and they all committed suicide because of these policies.
And what happened to the addicts who caused all the numbers to get so high by buying Chinese fentanyl in the first place? Well they were rewarded for their actions the rest of us have to continually pay for. They were given a nice clean sanitary place to shoot up, in a relaxing easy chair with a RV AND. A certified nurse standing by with narcan in case the OD!! How is this remotely fair to the other 99% of the country? It is insulting to those of us that followed the rules and are being punished EVERY SINGLE DAY WITH EXCRUCIATING PAIN for THEIR misdeeds.
I have worked with statistics a LOT in my profession and I could make these numbers say anything I wanted them to. The reality is, they didn’t bother to tell us it took 20 years to added together to get the numbers high enough to cause a panic. Also, when looking at the requirements for the numbers it was ANY drug related death thrown in there (just like COVID numbers which we all KNOW we’re inflated by hospitals to receive more money and yes, my mom is a hospital administrator and it’s a thing) also, of the deaths reported less than 1% of those deaths was from anybody in pain management. This whole thing is a knee jerk reaction and will NOT fix the problem. They have tried to stop the flow of drugs into this country since the 1980’s and haven’t made any progress, so all that is happening is we have given up being “humane” to humans and reserve that for our pets!! If you are going to continue down this road, I suggest legalizing physician assisted suicide, or at the very MINIMUM make insurance pay for all the “alternatives” they suggest replace pain meds, like massage, acupuncture, floating (which helps relieve the pressure of compressed nerves in the spine). You just took away our medicine and then expected us to pay hundreds of dollars a month MORE for treatments most people cannot afford. You better hope the disabled community doesn’t come together as a voting block because it encompasses THE largest amount of people if any other voting group! So when you are pushing for these alternative therapies, make them available to the person in disability, because I bet those numbers skyrocket because people can no longer function in their jobs even though they WANT to keep working, this makes it impossible.
I know this is not a popular opinion but maybe you should add some pain management doctors into your “panel” of doctors or maybe even some veterans who lost limbs for our country and are now made to suffer all over again by a country who doesn’t care about their pain or PTSD.
Personally my issues were caused by abuse where I was constantly kicked in the back for stupid crap like baking a pie in the wrong day. people in pain management are not there to get drugs, they are victims of violence, betterment, the elderly and some unlucky saps who just woke up in pain one day and their lives were changed forever.
I for one am exhausted from being curled up in a ball crying for hours on end because of the pain I am now forced to endure. So tell me…where is your compassion and empathy now? Probably still with the addicts who brought on their own problems or maybe some of them are just pain patients trying to self prescribe because the medical system in this country doesn’t listen to what their doctors say?
I have been denied surgery several times even though I have 3 doctors, who spent 12-14 years in school each, saying I NEED the surgery but the insurance company has decided it’s in their best interest to let me live in pain or die because that’s what it’s all about in the end, profit. I once thought America was the best country to live in but that is not the case. What would you do in my situation? If I speak up, I’m labeled an addict, if my doctor speaks up, hes labeled a pill pusher (even though he is NOT and it was always the last method of pain control he uses) the only people that CAN speak up are the ones who are AGAINST opioids period. Oh. And on a closing note, suboxone has worse side effects than opiates and is MOTE addictive than what it’s treating.
Unfortunately, the 10% of population that have the genetic predilection for addiction are getting in effect ,preferential treatment, Over the 90% that are just needing pain meds in appropriate dose for adequate pain control.
As a pain specialist, I see pts coming from other pain doctors who defer RXing pain meds due to the antiOpioid paradigm shift and the pressure from DEA and the very medical boards that first told doctors that we are not writing enough pain meds, just a few years ago….
It’s a sad day in pain management in US, as millions of patients are undertreated due to regulatory pressures and false premises of “opioid crisis”, which implies that pain patients are addicts and abusers of pain meds…. it is far from truth. The real crisis is in recreational/ illicit opioid world…. NOT in medically RXd pain meds.
Follow the money… the answer is there.