A new report today by the American Medical Association (AMA), North Carolina Medical Society (NCMS), and Manatt Health shows North Carolina is adopting life-saving strategies to combat the opioid epidemic.

The report, based on data, a review of policies and discussions with key policy makers, points to policies that have helped patients with opioid use disorder, including:  

• Increasing access to medication assisted treatment (MAT). The state Medicaid program and leading commercial payers have improved treatment opportunities for patients by making more available MAT, the evidence-based treatment prescribed by a physician. This was accomplished by eliminating administrative barriers, known as prior authorization, that require physicians to get approval before providing treatment. Expanding Medicaid would help thousands more patients access evidence-based care.
• Promoting access to comprehensive pain care. The state Medicaid program promotes individualized patient care plans, including supporting increased access to non-opioid pain management, while recognizing beneficiaries with chronic pain also might require opioids.
• Expanding access to the overdose-reversing drug naloxone and promoting harm reduction services.  More than 10,000 overdoses have been reversed due to increased access to and administration of naloxone by first responders and law enforcement and via distribution by community coalitions. Legalized and publicized syringe exchange programs also have reduced the spread of infectious disease and have helped link individuals with substance use disorder with health care services.

“North Carolina is making strides to enhance patients’ access to evidence-based care,” said AMA President-Elect Patrice A. Harris, M.D., M.A., and chair of the AMA Opioid Task Force. “While opioid prescribing has decreased in the state by more than 21 percent since 2013, we remain deeply concerned by increases in opioid-related overdoses — particularly from illicitly manufactured fentanyl and fentanyl analogs. We urge policymakers to redouble efforts to remove all barriers to MAT and comprehensive pain care, including expanding Medicaid to help thousands more North Carolinians access high quality medical care.”

“To truly have a positive impact on the opioid epidemic in this state, we must forge partnerships that collaboratively address the problem,” said North Carolina Medical Society CEO Robert W. Seligson. “That includes working together to offer waiver training and support to help providers offer MAT in their office; coordinating with community groups to provide resources to those struggling to recover from substance use disorder; and partnering with the justice system to help ensure compliance.”

One promising initiative the spotlight analysis found was Project OBOT—a “hub and spoke model” developed by the NCMS that provides training for physicians and other health care professionals to establish collaborative care teams in rural and remote counties, build partnerships with technology companies to streamline workflows, and work with recovery courts and other stakeholders to provide a broad continuum of services to enhance treatment and recovery for those with an opioid use disorder.

In addition to the state needing to expand Medicaid so tens of thousands of North Carolinians can have access to treatment for opioid use disorder and pain, the spotlight analysis also found areas where additional progress could be made:

• Ensure all prior authorization policies for MAT are removed. While Medicaid has taken this important step, it will be critical to monitor and evaluate Medicaid managed care plans as well as all payers in the commercial market to ensure they do not delay or deny care to patients seeking treatment for an opioid use disorder.
• Conduct oversight and enforce network adequacy and parity standards. The network adequacy standards established for Medicaid managed care plans provide clear guidance to those plans and could be used to strengthen Department of Insurance (DOI) guidelines for verifying that commercial insurers have adequate networks as well. DOI also could clarify parity standards for mental health and substance use disorder and use targeted market conduct exams to identify and remedy gaps in commercial insurance services.
• Further increase access to non-opioid treatment. In Medicaid, the state already has opted to cover important forms of evidence-based non-opioid and non-pharmacological alternatives for pain management. It could build on these efforts by continuing to review whether Medicaid covers all appropriate alternatives. DOI should work with commercial insurers to confirm that commercially insured patients have access to timely, affordable, comprehensive, multidisciplinary, multimodal pain care.

“Addressing this epidemic will require an ongoing, sustained effort comprised of multiple strategies and with coordination and partnership across a wide range of stakeholders, including law enforcement, education, health care, policymakers, philanthropy, advocates and the business community,” said Mandy Cohen, secretary of the state Department of Health and Human Services. “While we have made progress in addressing this crisis, we have much more work to do.”

Full report here: www.end-opioid-epidemic.org/NCSpotlight