Physicians must continue to lead, and policymakers must base further action on evidence-based interventions. The AMA’s Substance Use and Pain Care Task Force’s five recommendations build on previous work and are as follows:
Remove treatment barriers.
Remove barriers to evidence-based treatment for SUDs, cooccurring mental illness and pain. These include improved enforcement of laws and policies to ensure access to medication-based treatment for opioid use disorder (MOUD), including buprenorphine, methadone, extended-release naltrexone therapies, and cooccurring mental illness. Particular emphasis must be placed on ensuring protections for justice-involved individuals and for youth, peripartum, pregnant, postpartum and parenting individuals. This includes working to keep families together safely and eliminating health inequities that disproportionately harm marginalized and minoritized communities.
Support individualized pain care.
Support coverage for, access to, and payment of comprehensive, multi-disciplinary, multi-modal evidence-based treatment for patients with pain, a substance use disorder or mental illness. Additionally, coverage, access and payment should directly address racial, gender, sexual orientation, ethnic and economic inequities as well as social determinants of health. Particular emphasis must be placed on individualized patient care decisions, protecting patients with pain, a substance use disorder or mental illness from continued stigma and addressing a lack of access to evidence-based care or accepted best practices.
Support comprehensive public health and harm reduction strategies.
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 use drugs and other substances. Particular emphasis must be based on evidence-based strategies, including naloxone, sterile needle and syringe services programs, and integrating the perspectives of the recovery community and people who use drugs for nonmedical use in the development and delivery of those strategies.
Improve multi-sector collaboration.
Improve stakeholder and multi-sector collaboration in an effort to ensure that the patients, policymakers, employers, and communities benefit from evidence-based decisions. Policymakers should review laws and other policies to determine if they have had unintended consequences. Particular emphasis must be placed on efforts to ensure representation by marginalized and minoritized communities at every step in the clinical, policy and administrative processes. This also includes continuing efforts to build the workforce and enhance education and training with respect to pain, mental illness and SUDs for all health care professionals.
Collect better data.
Support patients with pain, mental illness or a substance use disorder (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 evidence-based treatment and prevention efforts. A renewed effort must be made to identify and support primary, secondary and tertiary SUD prevention efforts for children, adolescents and adults. This includes increased efforts to implement evidence-based strategies to address restrictions on care, overdose events and other harms experienced by patients with pain, mental illness or an SUD. Particular emphasis must be placed on collecting adequate, standardized data to eliminate inequities for historically marginalized and minoritized populations. Additional work must be done to address the increased complexity of access and treatment to SUD care as a result of the nation’s growing polysubstance use, overdose and death epidemic.