AMA Releases New Substance Use, Pain Recommendations

In September the American Medical Association (AMA) released recommendations for physicians and lawmakers to help end drug overdoses and deaths. The recommendations were created by a new task force, the Substance Use and Pain Care Task Force, which combines AMA’s Opioid Task Force and Pain Care Task Force and includes APA and more than two dozen other health organizations.

The recommendations focus on broad efforts to remove barriers and improve access to evidence-based care for patients with pain and/or substance use disorder (SUD) as well as to increase access to strategies for harm reduction.

The recommendations include the following strategies:

• Support patients with pain and/or mental illness, including 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 data, evidence-based treatment, and prevention efforts.

• Support coverage for, access to, and payment of comprehensive, multidisciplinary, multimodal evidence-based treatment for patients with pain, SUD, and/or co-occurring mental illness.

• Include—through coverage, access, and payment—ways of directly addressing racial, gender, sexual orientation, ethnic, and economic inequities as well as social determinants of health. This includes removing barriers to evidence-based treatment for SUD, co-occurring mental illness, and pain.

• 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 take illicit substances. This includes increased support for naloxone and sterile needle and syringe exchange services.

• Improve stakeholder and multisector collaboration to ensure that the patients, policymakers, employers, and communities benefit from evidence-based decisions.

“Physicians must continue to lead by example to help our patients with pain, SUDs, and mental illness,” AMA Board Chair and Task Force Chair Bobby Mukkamala, M.D., an otolaryngologist in Flint, Mich., said in a statement. “Removing barriers requires policymakers to join us in establishing a more effective and humane approach. Failure to adopt these policies will prolong the epidemic and our patients’ suffering.”

APA President Vivian B. Pender, M.D., hailed the recommendations as a foundation for meeting the epidemic of drug overdose and mortality head-on.

“We must approach this crisis from every angle and ensure that patients with comorbid pain and patients in marginalized communities have access to treatment that is offered by health and mental health professionals who understand the intricacies of substance use disorders,” Pender told Psychiatric News. “As psychiatrists, it is our responsibility not only to advocate for accessible, evidence-based care, but to offer it in a respectful way that addresses each patient as an individual with individual needs.”

Smita Das, M.D., Ph.D., M.P.H., chair of APA’s Council on Addiction Psychiatry and a clinical assistant professor of psychiatry and behavioral health sciences at Stanford University School of Medicine, voiced support for the recommendations on behalf of the council.

“Substance use disorders and mental illness are underaddressed and undertreated, and these recommendations will hopefully have an impact on our patients, colleagues, and systems,” Das told Psychiatric News. “Many of our patients also suffer from pain, so the joint recommendations are helpful. We especially appreciate the emphasis on evidence-based strategies and reducing barriers and stigma.”

Das said that expanding access to care and expanding the treatment workforce are critical to meeting the recommendations regarding patient support.

“APA has been advocating for improved education and training of all physicians to better screen, identify, and treat substance use disorders concurrently with other dual diagnoses,” Das said. “In addition to improved training and workforce strengthening, the other challenge will be to update systems of care to deliver on the AMA recommendations.”

Das encourages psychiatrists to be proactive in helping the AMA recommendations materialize, particularly with respect to the recommendation about supporting coverage for, access to, and payment of comprehensive, evidence-based treatment for patients with pain, SUD, and/or co-occurring mental illness.

“For individual psychiatrists, approaching SUD and pain with special attention to [this recommendation] can reduce the stigma and barriers our patients face,” Das said. “Screening for substance use, being familiar with treatment options, and [offering] harm reduction [strategies] can improve a patient’s journey and outcomes.” ■