Treat Addiction Like a Chronic Disease, ACP Recommends

The American College of Physicians (ACP) has called for addiction to be treated like any other chronic condition, such as diabetes. And that may mean lifelong care, the group states in policy recommendations published last week in Annals of Internal Medicine.

“Drug overdose deaths, particularly from opioids such as prescription pain relievers and heroin, is a rising epidemic,” Nitin S. Damle, MD, MS, MACP, the group’s president, said in a statement. “Substance abuse disorders are treatable chronic medical conditions, like diabetes and hypertension, that should be addressed through expansion of evidence-based public and individual health initiatives to prevent, treat, and promote recovery.”

Investing in treatment for substance abuse disorders makes sense, the paper states, because, “Evidence shows that for every dollar invested in drug prevention and treatment, the nation sees substantial savings.”

ACP said the rise of the opioid crisis alongside other substance abuse disorders, such as alcoholism, is sapping healthcare resources and create a “heavy societal burden.” Yet, care can be hard to come by. In 2014, the group said, only 18% of the estimated 22.5 million people who needed treatment for drug or alcohol problems received care. By contrast, roughly three-fourths of those who need care for diabetes, hypertension, or major depression have access.

The paper outlines what the crisis is doing to healthcare costs. “Hospitalizations for opioid use disorder rose from nearly 302,000 to more than 520,000 from 2002 to 2012, and costs for such care quadrupled to $15 billion in 2012. Charges for hospitalization for opioid use disorder with serious infections also quadrupled over the same time period to $700 million,” the paper states.

The result has been a rise in the number of accidental deaths, a category that includes drug overdoses. Deaths from overdoses are rising in the United States when causes like cardiovascular disease and cancer are killing fewer people. In the most recent CDC report on US mortality, life expectancy in the United States fell in 2015 for the first time in a generation, and age-adjusted death rate increased. Last month, Princeton economists Anne Case, PhD, and Angus Deaton, PhD, noted the inconsistent access to the US healthcare system as they shed more light on their groundbreaking 2015 finding about the rise of “deaths of despair,” including drug and alcohol poisoning and suicide, especially among whites with limited education.

ACP called for more research on addiction disorders, including the causes, treatment, and stigma associated with the disease.

The authors called for naloxone to be broadly available to opioid users, law enforcement, and emergency department teams. At the same time, there should be a shift away from criminalization of substance abuse and a greater focus on treatment. For the purposes of the policy paper, ACP treated marijuana as an illicit drug, even though it has been legalized or decriminalized in several states.

ACP made several recommendations in its policy paper:

· US physicians must become more familiar with clinical guidelines for prescribing painkillers. The CDC issued new guidelines last spring, aimed largely at primary care physicians, which call for paying closer attention to addiction history when prescribing opioids, and to use the smallest dose possible for only a few days after an event like surgery.

· Physicians must become familiar with non-opioid drugs and non-drug interventions for pain.

· More training is needed for the use of medication to treat addiction, such as buprenorphine-based treatment.

· Existing drug distributing registries and monitoring programs need to be improved, and a national monitoring system is needed. “ACP strongly urges prescribers to check Prescription Drug Monitoring Programs in their own and neighboring states as permitted prior to writing prescriptions for medications containing controlled substances,” Damle said.

The physicians’ group recommends stronger steps to require health insurers to cover mental health care, including substance abuse treatment, including enforcement of parity laws.

Reference

Crowley R, Kirschner N, Dunn AS, Bornstein SS. Health and public policy to facilitate effective prevention and treatment of substance use disorders involving illicit and prescription drugs: an American College of Physicians positon paper [published March 28, 2017]. Ann Intern Med. 2017. DOI: 10.7326/M16-295.