In this excellent video from the HMA Institute on Addiction, Dr. R. Corey Waller describes the research on the brain science behind addiction and the implications for public policy change (20 minutes into the video). He says, “In the criminal justice world, we have to stop criminalizing patients for having a disease that we have a treatment for. We know that that behavior can be defined based on craving. We know that that craving can be seen on a functional MRI. We know that it’s greater than starving and dehydration. And most importantly we know we have treatments for this. So to take someone who has very obvious behaviors of addiction and put them in jail with no treatment doesn’t make any sense.”
Category: Policy Research
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Use of Buprenorphine-Naloxone in the Emergency Department
Surveys indicate that up to 1.9 million Americans met criteria for an opioid use disorder (OUD) based on their use of prescription opioid medication alone in 2013. Another 300,000 were regular users of heroin. Deaths due to opioid overdose continue to rise, despite multiple policy interventions at the federal, state, and local levels. Many of these policy efforts have focused on prevention. Prevention is essential, but prevention won’t help the millions of people already addicted to opioids.
The Emergency Department is a health care setting in which patients with OUD commonly present, seeking more opioids to maintain their addiction, seeking help with opioid withdrawal, or in some tragic instances, needing emergency resuscitation for opioid overdose. Emergency Department (ED) physicians are thus uniquely positioned to intervene to help patients with OUD at a critical moment in the addiction cycle.
Download the Monograph: Use of Buprenorphine-Naloxone in the Emergency Department by David Kan, MD and Anna Lembke, MD. A monograph adopted by the California Society of Addiction Medicine Committee on Opioids and the California Society of Addiction Medicine Board of Directors, January 2018.
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Standards For Access To Addiction Medicine Services
Only about 10% of people, who need addiction treatment, get that treatment. Why? The causes are complex, but one core problem are barriers to systems of care. This is especially true for people with the double and triple stigmas of addictive illnesses, serious mental health conditions and incarceration. As first steps to addressing these ‘silos of care’ barriers for patients with addictive illnesses, The California Society of Addiction Medicine (CSAM)’s Integration and Access to Systems of Care Committee experts have written these guidelines for distribution. They recognize that incarcerated settings, licensed addiction treatment settings, and community-based behavioral health systems live under various funding streams, and differing regulations and statutes. However, any foundation for advancing care in these systems will depend on a foundation of evidence-based addiction medicine treatment. CSAM hopes these brief guidelines can be used by leaders and advocates to advance good medical care for people with alcohol and substance use disorders in these three systems of care.
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Minimum Insurance Benefits for Patients with Opioid Use Disorder
In 2015 California Society for Addiction Medicine (CSAM) published its survey of bronze-level plans offered by Covered California. The report indicated that, while coverage varied, none of the plans offered an acceptable level of coverage for the treatment of patients with opioid use disorders.
Major attention has been focused on the opioid epidemic from a state and national level. Medication Assisted Treatment (MAT) of opioid use disorders has proven to be the most effective form of treatment. Insurance companies claim that they offer full coverage for MAT. The California Society of Addiction Medicine conducted a statewide survey of its members and other physicians during the month of September 2016 to assess insurance barriers in California in the treatment of patients with opioid use disorders. Of the 800 surveyed electronically, it received a statistically significant response rate of 11%. The survey found that these companies impose major barriers to treatment.
Download the white paper: Insurance Barriers to Accessing Treatment of Opioid Use Disorders Identified by California Physicians. David Kan, MD, DFASAM, Chair, CSAM Committee on Opioids; November 2016.