America is at a Critical Juncture in the Drug Overdose Crisis. Expanding Access to Addiction Medicine is Key

By:  ASAM Staff

Since 1999, the United States has experienced more than 1 million drug overdose deaths. This horrific and avoidable milestone underscores the urgent need to act so that we, as a country, can better address the needs of people with substance use disorders and those at risk for overdose with evidence-based interventions and treatment, and ultimately, save lives.

Each life lost during the drug overdose crisis represents a friend, neighbor, or family member who was loved deeply, and their deaths leave heartbreak and grief in their wake. Even more heartbreaking is the systemic failure of our nation’s healthcare infrastructure to provide the evidence-based health care that we know is successful in treating the disease of addiction and preventing death.

Consider these startling statistics: according to the latest Substance Abuse and Mental Health Services Administration (SAMHSA) National Survey of Drug Use and Health, 40.3 million people aged 12 or older (14.5 percent) had a substance use disorder (SUD) in the past year; yet only 13 percent of people living with SUD received any form of treatment. Further, despite the availability of three safe, effective, FDA-approved medications shown to help people with opioid use disorder (OUD), just 11 percent of people with OUD in the U.S. received one of them.

ASAM pursues and promotes a future when addiction prevention, treatment, remission, and recovery are accessible to all, and recently reformulated its strategic plan to address the worsening overdose crisis and persistent treatment gap.

ASAM’s new strategic plan, for 2022-2025, articulates its aims to expand access to addiction medicine treatment and prevention to all those that need it. To these ends, over the next three years, ASAM will:

• Advocate for comprehensive benefit coverage, improved reimbursement, and appropriate compensation for the full continuum of addiction care;
• Support funding for research, education, and prevention;
• Champion addiction medicine access for all; and
• Advocate for reducing criminal legal system interference with the delivery of addiction care.

ASAM will advocate for comprehensive benefit coverage, improved reimbursement, and appropriate compensation for the full continuum of addiction care.

Addiction care must be recognized as an essential health benefit––and be covered and reimbursed appropriately. Unfortunately, too few individuals with SUD receive the addiction care services they need due to narrow networks, onerous utilization management policies, lower reimbursement rates for addiction medicine professionals, and high cost-sharing requirements. These insurance barriers must be addressed to improve patient access to evidence-based, addiction care services.

Moreover, comprehensive benefits must include the full spectrum of addiction care and embrace harm reduction – effective benefits should involve engaging people in overdose prevention and addiction treatment and prevention services even when individuals may not be initially ready to stop using substances.

Insurance plans should also provide coverage and payment at parity with general medical/surgical benefits, a federal law requirement that will need greater enforcement.

Research and a recent government report show that federal law still has not succeeded in removing many financial barriers to addiction treatment, despite modest progress. According to SAMHSA, one in five (19.1 percent) Americans 12 and older with SUD said they needed treatment at a specialty facility but couldn’t access it because they lacked health care coverage or were not being able to afford the cost of treatment. One indicative report, released by the Maryland Insurance Administration in 2018, found that just one of 13 insurance carriers had sufficient mental health and substance use providers in its network to ensure access to non-urgent services within 10 days, as required by state law. This stark finding is sadly representative of what is happening in many states across the country.

ASAM will continue to advocate for improved reimbursement, network adequacy, insurance parity, and payment models that expand access to high-quality addiction care.

ASAM will support funding for research, education, and prevention.

While clinicians, scientists, and researchers have made tremendous strides over the past several decades to better understand addiction and to investigate and develop evidence-based treatments and prevention strategies, there is still much more to learn.  ASAM will continue supporting funding for research, education, primary and tertiary prevention measures, innovative treatment initiatives, recovery support services, and programs that address social determinants of health.  By investing in such initiatives, we can continue to improve our ability to treat individuals at risk for, or with, addiction and provide the latest forms of evidence-based care.

As new addiction treatments are developed, they must be adequately funded to ensure their success and sustainability. ASAM’s new strategic plan commits the organization to advocate for that funding, as well as for grants that incentivize the integration of successful grant-based prevention and treatment initiatives into sustainable funding sources.

Finally, robust loan repayment and training programs for addiction medicine professionals are critical to ensure a workforce equipped to meet this crisis. Unfortunately, the United States continues to experience a massive shortage of physicians and other clinicians with the requisite knowledge and training to prevent, identify, and treat addiction.  With overdose deaths skyrocketing to record highs during the COVID-19 pandemic, the problem is only getting worse, underscoring the need to invest in a larger and stronger addiction treatment workforce. By increasing funding for strategic loan repayment programs and key training programs, policymakers can incentivize more students and professionals to specialize in the prevention and treatment of addiction, increase the number of addiction medicine professionals in high-need communities across the country, diversify the addiction treatment workforce, and ultimately increase patients’ access to lifesaving services.

ASAM will champion addiction medicine access for all.

Everyone with the disease of addiction should have access to safe, effective prevention and treatment services.  Yet, stigma around drug use and SUD is still pervasive, even in the medical setting.  According to a July 2019 survey of healthcare professionals in Massachusetts, less than 50 percent of emergency medicine and family medicine/internal medicine providers believed that OUD is treatable.  Likewise, far too many people wrongly believe that addiction is a moral failing rather than a treatable medical disease.  This stigma has contributed to preventable overdose deaths and created barriers for patients to access addiction medicine, especially in historically marginalized communities.

In the years ahead, ASAM will continue its work to reduce this stigma and eliminate barriers to addiction care for all Americans––including individuals involved with the criminal legal system. ASAM will advocate to optimize the delivery of high-quality addiction care through various modalities, including telehealth, which has played a major role throughout the COVID-19 pandemic, and eliminate barriers to the clinically appropriate delivery of addiction medications and psychosocial treatments.  These actions will be bolstered by ASAM’s advocacy to address racial and other inequities in addiction care and to support a public health and population approach to drug use and addiction.

ASAM will advocate for reducing criminal legal system interference with the delivery of addiction care.

High incarceration rates do not reduce alcohol and other drug use, nor do they address the needs of individuals with SUDs.  Because substance use is a health issue and addiction is a disease, ASAM supports eliminating criminal penalties for personal use drug possession.  While reducing reliance on the criminal legal system to penalize personal drug use may be controversial to some, it is clear the current carceral approach is failing people at risk for, and with, addiction and their communities.

In ASAM’s public policy statement on racial justice in addiction medicine, we described how U.S. drug policy has supported systemic racism.  This is evident in the disproportionate incarceration rates, treatment barriers, and ongoing discrimination of people of color with SUD despite data suggesting that people of color and white people use drugs at similar rates.

Moreover, too few people who are involved with the criminal legal system are receiving the addiction treatment that they need.  This must change.  Research shows that roughly two-thirds of persons who are incarcerated meet the medical criteria for substance use disorder. Failure to provide the services necessary to treat their medical condition can have deadly consequences: individuals returning to the community after being incarcerated are roughly 129 times more likely to die from an overdose compared to the general population.  Patients involved in the criminal legal system must be able to access the addiction treatment that can save their lives and promote recovery—including all FDA-approved medications for treating OUD.

Finally, the climbing overdose death rate suggests an urgent need to prioritize non-carceral strategies that meet people who use drugs where they are, keep them alive, and connect them to evidence-based care.  To that end, ASAM will continue to advocate for the creation of pilot overdose prevention sites, expanded use of contingency management, and utilization of effective public health and patient-centered interventions, including harm reduction.   

Conclusion

With drug overdose deaths reaching historic highs, the United States is facing a watershed moment.  While the nation knows how to prevent and treat addiction, addiction medicine services are not being utilized as widely and effectively as the crisis demands.  Access barriers resulting from inadequate coverage, too few addiction medicine professionals, lingering stigma, and criminal legal system interference with addiction care delivery are all negatively impacting communities across America.

Our country can no longer meet this crisis with half measures.  In the years ahead, ASAM will work diligently to expand access to addiction medicine in groundbreaking ways as part of its new strategic plan.  By striving to fill the gaps and strengthen the United States’ addiction prevention and treatment infrastructure, ASAM remains optimistic that it can help achieve a future when addiction prevention, treatment, remission, and recovery are available and accessible to all.