Addressing Gaps in Evidence-Based Opioid Policy and Practice
Although evidence from health policy research should inform policymaking, researchers and policymakers don’t always communicate. A conference sponsored by the Center for Health Economics of Treatment Interventions for Substance Use Disorder, HCV, and HIV (CHERISH) – a NIDA-funded Center of Excellence – and hosted by the Leonard Davis Institute of Health Economics (LDI) sought to close this gap…if even for a day.
Substance Use Disorder in America: Research to Practice, and Back Again brought researchers, policymakers, and other stakeholders together to discuss evidence-based approaches to address substance use disorder and the opioid epidemic in America. Specifically, the conference was designed to improve the translation of current research for policy stakeholders and to inform future research so that it can be responsive to policymakers’ needs.
Despite the wide acceptance of evidence-based practice by medical professionals, research is rarely a part of the decisions made by policymakers. Instead, policymakers often rely on intuition, ideology, or conventional wisdom. Noting that policymakers most often credit in-person relationships with researchers as the most influential factor in determining the use of research evidence, the conference stressed the importance of establishing these networks. Early engagement with policymakers can help researchers identify meaningful research questions, and encourage researchers to become a part of the translation from evidence to policy and practice. These relationships can help policymakers consider the evidence as they try to make the best use of scarce resources. Ultimately, personal relationships are key to closing the gap and establishing evidence-based policy and practice, particularly in curbing substance use disorders and the opioid epidemic.
The conference wasted no time putting these connections to the test. Throughout the conference, researchers, policymakers, and clinicians were challenged to work together to come up with feasible strategies to curb the opioid epidemic. In an afternoon exercise, small, mixed groups of attendees reacted to a scenario in which a young patient died of an overdose despite repeated encounters with the health system. The scenario highlighted gaps in treatment, follow-up, and coordination. The groups identified evidence-based strategies for addressing these issues, and came back together to present their ideas to the larger group. In a post-conference survey, attendees ranked the most promising and feasible ideas within four categories, as shown below:
Quality of Treatment
- Tie insurer payment to minimum standards for treatment based on evidence-based practice and continuity of care
- Eliminate or reduce the burden of regulations on prescribing buprenorphine
- Create an independent accreditation body that rates treatment facilities on meeting standards of care, and provides a publicly-available list of available treatment centers and their quality scores.
Continuity of Care
- Develop in-person or telephone care coordination following discharge, through peer support, or MAT providers
- Promote hub-and-spoke models to ensure primary care physicians feel comfortable and supported prescribing MAT
- Promote emergency department induction of buprenorphine prior to discharge or hospital admission
Opioid Prescribing / Pain Management
- Require insurers to cover alternative pain treatment modalities, so that opioids are not the default pain management
- Tie the use and development of prescription guidelines to federal funding
- Develop a national state scorecard on opioid prescribing – ranking the states in relation to their goals – and hold governors responsible
- Create a centralized system of treatment facilities and providers where patients can sign up themselves (Airbnb-type model)
- Increase family and consumer marketing campaigns
- Create a consumer-rating metric of treatment programs
- Provide incentives for individuals to seek treatment (starting with research on best incentive programs)
The conference achieved its short-term objective of developing new relationships between researchers and policymakers and demonstrating collaborative work. Ultimately, its long-term success will depend on the forged connections that will continue to close the communication gaps between researchers and policymakers.