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Can We Fight Opioid Use Disorder by Filling Data and Policy Gaps?

Allison Inserro
Which data, policy, and information gaps exist throughout the healthcare system and need filling in order to combat opioid use disorder (OUD) through better prevention and treatment strategies? Two recent reports discuss how these gaps are worsening efforts to fight OUD.
Funding Issues
With so many players involved at every level, neither report mentioned what it will cost the United States to undertake an overhaul of these systems. Some of the cost, such as coming up with a uniform PDMP, has not been calculated, Dentzer said.

Van Antwerp said any discussion of funding needs to include “the value of prevention and the value of care management and the value of MAT.” In addition, he said, society is starting to gain a greater insight into the direct and indirect costs of complications of OUD.

Unintended Consequences
Some doctors are reporting that it is getting more difficult to treat patients with cancer or other long-term pain, and Thursday an editorial in JAMA Oncology noted that the CDC’s opioid guidance conflicts with how patients with cancer, as well as those post-treatment, are managed.

Both Van Antwerp and Dentzer acknowledged those concerns.

“'Are we overcorrecting?' is essentially the key question,” Van Antwerp said.

Without evidence-based standards, “the easy answer is to be very restrictive” with prescribing opioids, he said. But as an understanding of risk grows, perhaps the trend will shift back.

In addition, restrictive prescribing to people who already use opioids may also have the unintended effect of sending them to the illicit drug trade to use heroin and fentanyl.  

Privacy Issues
The release of information about substance use disorder treatment is protected under a regulation known as 42 CFR Part 2, and there are some in the field who think that there are some pieces of the law that could be changed in order to facilitate improved integration between addiction providers and other parts of the healthcare system. But because stigma still exists with getting treatment, any changes that Congress considers would have to be carefully considered, both organizations say.

NEHI gave the example of a provider who has a pregnant patient who also is getting treatment for an opioid problem. During the same visit, her information must be entered separately into 2 different systems, creating a more complex workflow for the provider. “That just doesn’t make any sense,” said Dentzer.

Any efforts that involve the increased collection of patient data with the aim to improve their care may run into some resistance, and Van Antwerp said it is not an easy topic to discuss but one that has to happen. Patients need to know that the collection of data “offers value to them and not just to somebody else,” he said, and for a clinical purpose to better understand risk.

References
1. Preston B, Van Antwerp G, Korba C. Strategies for addressing the opioid epidemic. Deloitte Center for Health Solutions. May 18, 2018. www.deloitte.com/insights/us/en/industry/health-care/strategies-health-plans-pbms-to-stem-opioid-crisis-with-data-technology.html. Accessed May 31, 2018.

2. Addressing data and information gaps contributing to opioid use disorder. Network for Excellence in Health Innovation. May 23, 2018. www.nehi.net/publications/80-addressing-data-and-information-gaps-contributing-to-opioid-use-disorder/view. Accessed May 31, 2018.

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