For you to become familiar with trends in policy changes in state Medicaid programs to address the opioid crisis.
In addition to clinical practice changes and new funding, state Medicaid programs have also responded to the crisis in key areas related to reducing supply, harm reduction and access to treatment drugs.
The Big Topics in This Lesson
1- Reducing Supply
2- Harm Reduction
3- Increasing access to treatment drugs
Lesson Q & A
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Reducing supply- Many of the recent changes in policy have been focused on reducing the amount of opioids that are diverted from legitimate sources into the illegal drug market. These efforts include things like:
- Take-back programs for unused scripts / pills- Laws passed in 2010 allowed police departments and pharmacies to accept controlled substances from long term care facilities and individuals.
- Patient restriction programs- in these types of programs, patients likely to be at risk of addiction or exhibiting drug seeking behavior are identified and limited to 1 doctor and 1 pharmacy. These are also often referred to as “lock-in” programs. In 2015, 28 Medicaid programs had a patient restriction program.
Harm Reduction Approaches- One of the approaches to the crisis is to increase harm reduction programs. Harm reduction is based on approach that accepts drug addiction as part of today’s culture and instead of seeking to eliminate drug addiction entirely, these programs instead seek to minimize the harm (overdose deaths and disease impacts) caused by addiction. Examples of harm reduction approaches include:
- Safe injection sites – often referred to locally as “needle parks.” These are places that the police do not enforce drug laws, but instead provide clean needles and rescue medicines for when addicts overdose.
- Needle exchange programs – These programs provide sterile needles and syringes to addicts. While federal funding can not be used for these in the U.S., there has been a long history of these programs in the U.S. dating back to the early days of the HIV crisis when researchers first began to understand that intravenous drug use was one of the risk factors for contracting the disease.
- Increased availability of rescue meds- Many states have made recent changes to increased availability of drugs like Naloxone (brand name Narcan). Examples include making Narcan available without a prescription, as well as police officers beginning to carry it.
Medicaid policies designed to make treatment more available – There are a wide range of policies at the Medicaid program (state) level that control how available treatment drugs are for the addicted population. The table below provides a summary of what the different policies looked like in terms of state adoption in 2013. Since increased awareness of the opioid crisis, many states have relaxed prior authorization rules and treatment limits.
New Terms from this lesson:
- Harm reduction programs– approaches that accept drug addiction as part of today’s culture and instead of seeking to eliminate drug addiction entirely, these programs instead seek to minimize the harm (overdose deaths and disease impacts) caused by addiction.
- Safe injection site– also known as “needle parks” are one of the programs designed to reduce harm in the opioid addict population by offering rescue medications and clean needles to addicts.
- Take back programs– Laws passed in 2010 allowed police departments and pharmacies to accept controlled substances from long term care facilities and individuals.
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