Introduction to Improving Telehealth and Virtual Care for Pain Management and Opioid/Substance Use Disorder

June 29, 2022

Publication Summary

The future of pain management and opioid and substance use disorder care requires an integrated, hybrid approach—blending both in-person and virtual care—that can be adapted for the individual needs of a diverse patient population. A new NAM Discussion Proceedings provides a summary of conversations about the current telehealth and virtual care environment and introduced key concepts as well as some of the benefits of and barriers to advancing telehealth.

The 3Cs Framework for Pain and Unhealthy Substance Use: Minimum Core Competencies for Interprofessional Education and Practice

June 6, 2022

Publication Summary

Adequate, efficient, effective, and compassionate care for pain and unhealthy substance use requires a health care workforce that is appropriately prepared to deliver that care. A new framework from the NAM’s Action Collaborative on Countering the U.S. Opioid Epidemic outlines minimum core competencies for all health care professionals who encounter patients experiencing pain or unhealthy substance use.

Read more about the framework and the authors’ approach to addressing this complex issue.

Stigma of Addiction Summit: Lessons Learned and Priorities for Action

January 31, 2022

Publication Summary

Stigma directly harms people experiencing addiction, as it can alienate them from loved ones and peer support, contribute to delays in seeking medical treatment, and can even manifest in shame around taking evidence-based medications for opioid use disorder.

The NAM Action Collaborative on Countering the U.S. Opioid Epidemic held a national convening in June 2021, in collaboration with the Dell Medical School at the University of Texas at Austin and Shatterproof, to discuss the negative impact of stigma on people who experience addiction and elevate action-oriented strategies to address and eliminate these harms.

This NAM Discussion Proceedings summarizes the conversations held at the Summit and identifies priorities for action to reduce stigma and its negative impacts.

Educating Together, Improving Together: Harmonizing Interprofessional Approaches to Address the Opioid Epidemic

December 16, 2021

Publication Summary

The opioid epidemic is complex and ever-evolving. In order to ensure future generations of health care professionals and health educators are equipped to reverse the deadly trends of the opioid crisis exacerbated by COVID, there is a critical need to identify and address professional practice gaps (PPGs) related to pain management, opioid use disorder (OUD), and other substance use disorders (SUDs) and integrate those best practices into care.

A new National Academy of Medicine Special Publication outlines five data-informed strategies to achieve those goals: establishing minimum core competencies, aligning accreditation, fostering interprofessional collaboration across regulators, investing in continuing education, & harmonizing practice improvement. Together, these priorities have the opportunity to advance a person- and family-centered approach for the continuum of health professions education to more effectively respond to the opioid crisis and inform the responses to future complex public health crises.

NAM Action Collaborative on Countering the U.S. Opioid Epidemic Research Agenda

April 19, 2021

Publication Summary

The impact of COVID-19 has exacerbated existing challenges in combatting the U.S. opioid epidemic and highlighted the fragility of our nation’s addiction care system. The need for a more robust system to support those with substance use disorder and ensure a comprehensive continuum of care has never been more clear.

In response, the National Academy of Medicine’s Action Collaborative on Countering the U.S. Opioid Epidemic has outlined a comprehensive list of cross-sectoral research priorities designed to identify a responsive, evidence-based, and COVID-19-informed path to reinforcing the systems that educate and train health professionals, care for individuals who experience pain and provide prevention, treatment, and recovery services for substance use disorders.

Guide for Future Directions for the Addiction and OUD Treatment Ecosystem

April 5, 2021

Publication Summary

Identifying, addressing, and closing existing gaps in the addiction and opioid use disorder treatment ecosystem is a vital step in addressing America’s epidemic of drug overdose and death.

Authors of a new individually-authored discussion paper outline major gaps in the treatment ecosystem through the framework of “the 4 Cs”: capacity, competency, consistency, and compensation. Under each major header, the authors identify areas that could benefit from sustained investment, further research, or applied expertise, including naloxone distribution, ensuring payment parity, identifying successes in telemedicine during COVID-19, and ensuring consistency of high-quality care.

Combatting the Stigma of Addiction – The Need for a Comprehensive Health System Approach

November 9, 2020

Publication Summary

The COVID-19 pandemic has increased stress on the health system, which in turn exposed and exacerbated the barriers to care often faced by individuals with opioid use disorder (OUD). Creating robust efforts to call attention to stigma and build individual and structural competency is necessary to drive change. The authors of a new individually-authored commentary call for a cohesive, evidence-driven effort to eliminate stigma against OUD.

The American Opioid Epidemic in Special Populations: Five Examples

October 26, 2020

Publication Summary

The United States is in the midst of an unprecedented crisis of prescription and illicit opioid misuse, use disorder, and overdose. Although the crisis has affected large swaths of the U.S. population, it has impacted certain segments of the population with an extra level of intensity—justice-involved populations, rural populations, veterans, adolescents and young adults, and people who inject drugs. Research has clearly shown that solutions for the opioid overdose epidemic are not one size fits all, and special attention should be paid to these populations that may be suffering unduly.

The discussion paper “The American Opioid Epidemic in Special Populations: Five Examples” focuses on these five identified populations and, for each, reviews why the population warrants focused attention, current barriers encountered in accessing care, promising approaches in supporting this population, and high-impact research and action priorities.

Best Practices, Research Gaps, and Future Priorities to Support Tapering Patients on Long-Term Opioid Therapy for Chronic Non-Cancer Pain in Outpatient Settings

August 10, 2020

Publication Summary

Ensuring high-quality, respectful, and appropriate management of chronic non-cancer pain (CNCP) in the context of the U.S. opioid crisis is a critical and complex endeavor. Unfortunately, data regarding the best way to proceed with care for these patients in terms of opioid maintenance or tapering are lacking. The evidence supporting the use of opioids in managing CNCP is weak, and there is now strong evidence that chronic opioid use among CNCP patients can be detrimental, particularly at high doses.

The discussion paper “Best Practices, Research Gaps, and Future Priorities to Support Tapering Patients on Long-Term Opioid Therapy for Chronic Non-Cancer Pain in Outpatient Settings” focuses on key decision points and available evidence to support tapering strategies for specific patient populations of long-term opioid use being treated for CNCP in the out-patient setting. This document summarizes the key messages from the discussion paper, as well as identified priorities for future research. It must be reiterated that the needs of each patient are unique and should be approached on a case-by-case basis. Clinicians should review the risks and benefits of tapering for each patient and proceed in a way that is informed by individual circumstances.

Improving Access to Evidence-Based Medical Treatment for Opioid Use Disorder: Strategies to Address Key Barriers Within the Treatment System

April 27, 2020

Publication Summary

Though medications for opioid use disorder are effective and approved by the FDA, almost four in five Americans with opioid use disorder (OUD) do not receive treatment with these medications. The gap in access to evidence-based care, including treatment with these medications, stems in part from barriers to change within the health care system. An individually authored discussion paper by members of the National Academy of Medicine’s Action Collaborative on Countering the U.S. Opioid Epidemic identifies nine key barriers to access, use, and delivery of evidence-based treatment and focuses on strategies that can be employed by providers, researchers, payers, institutions, educational and accrediting bodies, and regulators to overcome barriers and move toward a more functional treatment system for all. The barriers are divided into five categories: provider barriers, institutional barriers, regulatory barriers, financial barriers, and barriers to engagement within the treatment system.

The paper’s authors present 25 potential strategies to address these barriers. Some are achievable immediately, and some will need to be executed over a longer term. All the strategies work toward the end goal of improving access to evidence-based medical treatment and better care for those with OUD.

Dismantling Buprenorphine Policy Can Provide More Comprehensive Addiction Treatment

September 9, 2019

Publication Summary

Reversing the trends of the opioid epidemic will require as many qualified practitioners as possible, willing to provide their patients the care they need. Every health care provider should be empowered to give their patients the care they need if it is safe and reasonable, but they need education and clinical support. Restrictions on clinicians, along with stigma around addiction treatment, are impeding the abilities of health care providers to adequately treat opioid use disorder. This individually authored commentary includes potential solutions to broadening access to care, and how the health system can support clinicians to provide this care.