Task Force Makes Recommendations on SUD, Pain, Mental Health

October 14, 2021, 11:10 a.m. Michael Devitt — A new Substance Use and Pain Care Task Force formed by the AMA with the AAFP and other partners has released five recommendations aimed at removing barriers, improving access to care and increasing access to harm-reduction strategies for patients with pain, substance use disorders or mental illness.  

The recommendations are:

1. Support patients with pain, mental illness or an SUD by building an evidence-based, sustainable and resilient infrastructure and health care workforce rather than continuing a crisis-driven approach that has led to multiple unintended negative consequences, including one-size-fits-all strategies, continued stigma and widespread gaps in evidence-based treatment and prevention
   efforts.
2. Remove barriers to evidence-based treatment for SUDs, co-occurring mental illness and pain.
3. Support coverage for, access to and payment of comprehensive, multidisciplinary, multimodal evidence-based treatment for patients with pain, an SUD or mental illness.
4. Broaden public health and harm reduction strategies to save lives from overdose, limit the spread of infectious disease, eliminate stigma and reduce harms for people who use drugs and other substances.
5. Improve stakeholder and multisector collaboration in an effort to ensure that patients, policymakers, employers and communities benefit from evidence-based decisions.

Each recommendation includes additional guidance along with areas of specific emphasis, many of which focus on addressing longstanding health-related inequities. The first recommendation, for example, states that “particular emphasis must be placed on collecting adequate, standardized data to eliminate inequities for historically marginalized and minoritized populations,” while the third recommendation includes the statement that “coverage, access and payment should directly address racial, gender, sexual orientation, ethnic and economic inequities, as well as social determinants of health.”

Recommendations Follow Report’s Findings

The new task force posted its recommendations shortly after the AMA issued its 2021 Overdose Epidemic Report. Among the more relevant findings, the report stated that while opioid prescriptions have decreased more than 44% between 2011 and 2020, drug-related overdose deaths have continued to rise, and reached an all-time high of more than 94,000 last year.

The Overdose Epidemic Report also listed seven action steps directed toward policymakers on removing barriers and increased access to care, many of which align with the new task force’s recommendations.

“Policymakers and other stakeholders have a choice of whether to pursue evidence-based strategies to support patients’ access to life-saving and life-affirming care,” Mukkamala said in the report. “Every effort must be made to remove health inequities and other barriers for patients with SUDs, mental illness and … pain. More of our loved ones will suffer and die if these barriers remain.”

AAFP Representative Offers FP Perspective

Robert “Chuck” Rich, M.D., of Bladenboro, N.C., who has represented the AAFP on the Opioid Task Force since the Academy was asked to join in 2015, explained the decision to create the new task force, as well as the role he and other AAFP members played in issuing the new recommendations.

“As the work of the Opioid Task Force was increasingly covered by the multiple pain management and prescribing guideline efforts across the United States via the multiple federal, state, specialty and system-based task forces, the AMA felt that the work of the Opioid Task force could now be best accomplished by rolling that task force into the greater combined Substance Use and Pain Care Task Force,” Rich told AAFP News.

“As participants on the Opioid Task Force and then the combined task force, I, along with staff from the Commission on Health of the Public and Science, had the opportunity to contribute to the development, review and finalization of those recommendations,” he added.

Asked how the recommendations would influence the way family physicians care for patients who are in pain or have an SUD or mental illness, Rich addressed the topic from two perspectives.

“On a broad scale, our members should see an expansion of resources over time to provide pain care, SUD care and behavioral health care for their patients,” said Rich. “Granted, full implementation of these recommendations will require action by federal, state and local policymakers, but the recommendations can serve to focus attention on and subsequently facilitate action regarding the issues of pain care, mental illness and SUD.

He added that once policymakers adopt the recommendations, FPs should see relaxed regulation of medication-assisted treatment for SUD, leading to better access. He noted that state delegations to the Academy’s Congress of Delegates have submitted several resolutions over the years calling for such an outcome.

“Locally, our members may also note an expansion of local and state task forces dealing with the issues of SUD and mental illness in response to the recommendations,” he added.

Rich also highlighted elements of two recommendations that he thought would be of particular interest to AAFP members, and that he will be personally watching to see whether they gain acceptance among FPs and policymakers.

“Recommendation two singles out justice-involved individuals, youth and pregnant individuals as needing increased access to SUD care and behavioral health care. Improvement in care for these population groups indicates to me that this recommendation has been received, as I continue to see substantial need for expanded SUD and behavioral health care for these groups across the United States, particularly in marginalized communities.

“Similarly, in recommendation three, I would pay close attention to the access and payment issues surrounding pain and SUD treatment, particularly when those services are being provided in our offices. Recognizing the family physician role in improving access to those services and then incentivizing the family physician for providing those services in our communities of need would again indicate to me that policymakers understand the importance of recommendation three and our importance in meeting that recommendation.”

Rich concluded by noting that previous efforts to address the opioid epidemic have sometimes produced unexpected — and unwanted — results. To prevent this, he advised AAFP members to remain vigilant and monitor the impact of the new recommendations on clinicians and their patients.

 “As a family physician who supports and advocates for these recommendations, I urge all to monitor their implementation to make sure that the family physician remains an integral part of the care team addressing these care issues for our patients, avoiding further fragmentation of care,” he said.

The AAFP has prioritized addressing substance use and has developed numerous educational and practice management resources for members. Additionally, the Academy continues to advocate for evidence-based policies that are patient-centered with appropriate access to care and coverage for services. Members are encouraged to access the resources listed below for additional information and guidance.