Advancing Racial Justice in Health Care through Addiction Medicine
ASAM’s Public Policy Statement on Advancing Racial Justice in Health Care through Addiction Medicine is the second statement of ASAM’s policy series on racial justice. This second statement focuses on actions that healthcare professionals, healthcare systems, institutions, and organizations, professional medical entities, researchers, and health professional educators can take to help advance addiction medicine and its role in addressing health disparities for people of color.
Hepatitis C Virus, Substance Use, and Addiction
Opioid use disorder (OUD) and infectious diseases are intertwined public health crises; hepatitis C virus (HCV) is the most prevalent bloodborne infection associated with drug use. Incidence and prevalence of HCV infection have increased significantly as a result of increasing rates of injection drug use, yet the introduction of curative direct acting antiviral (DAA) HCV therapies offer promise in reducing disease burden and transmission.
Recognition and Role of Addiction Specialist Physicians in Health Care in the United States
Addiction specialist physicians (ASPs) include physicians from multiple different primary specialties. Four medical subspecialty certifications for ASPs demonstrate and define expertise in addiction treatment: Subspecialty board certification in addiction medicine by the American Board of Preventive Medicine (ABPM); Subspecialty board certification in addiction psychiatry by the American Board of Psychiatry and Neurology (ABPN); Subspecialty board certification in addiction medicine by the American Osteopathic Association (AOA); or Certification by the American Board of Addiction Medicine (ABAM).
Morphine Milligram Equivalents for Medications for Opioid Use Disorder (MOUD)
This difference in doses of methadone and buprenorphine used to treat addiction and opioids used to treat pain may cause confusion among policymakers and payers attempting to set policies to prevent opioid overdose by limiting MME, as well as among state medical board officials attempting to enforce clinical guidelines and stem the over-prescription of opioid analgesics.
Regulation of the Treatment of Opioid Use Disorder with Methadone
This policy statement outlines existing regulatory barriers that prevent broader access to methadone treatment for OUD and summarizes current challenges to optimizing the quality of care offered by OTPs. Recommendations address ways to improve both access to, and the quality of, methadone treatment for OUD by making such treatment more patient-centered and integrated with other medical care. Such improvements are expected to reduce overdose deaths and improve health outcomes.
Overdose Prevention Sites
The United States has seen staggering increases in drug overdose deaths since the beginning of the 21st century. The 12 months ending in May 2020 witnessed the largest number of drug overdose deaths for a 12-month period ever recorded.
Patient Review and Restriction (PRR) Programs
Patient Review and Restriction (PRR) programs, also known as pharmacy “lock-in” programs, allow payers, including State Medicaid programs and commercial insurers, to curb a beneficiary’s overutilization, and possible misuse, of physician services and/or prescription medications by restricting the patient to a single designated provider, pharmacy, or both.
Use of Naloxone for the Prevention of Opioid Overdose Deaths
Naloxone is a remarkably effective, inexpensive and safe medication. It acts quickly, has no addictive potential, may be dispensed by injection (preferably intramuscular) or intranasally, and has mild side effects (other than precipitating opioid withdrawal) when used at the lowest effective dosage for reversal.
Advancing Racial Justice in Addiction Medicine
This is the first of a series of policy statements on racial justice through which ASAM reiterates the fundamental axiom that systemic racism is a social determinant of health that has had profound, deleterious effects on the lives and health of BIPOC.
Access to Medications for Addiction Treatment for Persons Under Community Correctional Control
Individuals under community correctional control include those on probation or parole. People on probation may have been sentenced to a term of supervision in the community or may be serving their sentence in the community in lieu of incarceration, the latter of which includes those involved with problem-solving courts such as drug courts, mental health courts, and veterans’ courts, among others.
Cannabis is a plant that has been used for its intoxicating effects for at least a century in the United States and for longer in other cultures. It also has a long history of use around the world for purported medical benefits. More than 100 different cannabinoids have been identified in cannabis.
Treatment of Opioid Use Disorder in Correctional Settings
This policy statement describes the standard of care that ASAM believes all detained and incarcerated individuals with OUD should receive. ASAM also advocates for systemic changes to ensure universal access to such care within correctional institutions.
Third-Party Payment for Addiction Treatment
This policy statement addresses some of the key issues facing clinicians and third-party payers as they work together for the benefit of patients to solve the real-world practical problems of access to care, reimbursement for professional services, insurance benefit design, and health plan clinician network adequacy.
Electronic cigarettes, also referred to as e-cigarettes, vaporizers or electronic nicotine delivery systems (ENDS), are non-standardized, battery-operated devices that use a “liquid” that most commonly would contain nicotine, as well as varying compositions of flavorings, in addition to propylene glycol, vegetable glycerin as vehicle forming a vaping cloud when exhaled, and other ingredients.
Physicians and Other Healthcare Professionals with Addiction
This policy statement articulates the American Society of Addiction Medicine’s recommendations for promoting the health of healthcare professionals with addiction and thereby contributing to their safe practice.
Endorsed Public Policy Statement on Buprenorphine Administration in the Emergency Department
The policy statement acknowledges the increasing number of opioid-related emergency department (ED) visits and fatalities occurring across the nation, before endorsing the administration of buprenorphine to appropriate patients in the ED to treat opioid withdrawal and to reduce the risk of opioid overdose and death following discharge, as well as the administration of buprenorphine in the ED as a bridge to long-term addiction treatment.
Ethical Use of Drug Testing in the Practice of Addiction Medicine
Drug testing uses a biological sample to detect the presence of drugs and/or drug metabolites in a patient’s body. Drug tests are ordered by physicians in a range of medical specialties, but drug testing has particular utility in addiction practices.
Medical Ethics with Annotations Applicable to Addiction Medicine
This document aims to adhere to the basic AMA Principles of Medical Ethics with annotations to help guide the ethical decision-making of those clinicians practicing addiction medicine.
ASAM supports a wide variety of measures to prevent alcohol and other drug-related problems in contemporary society, understanding that carefully thought out prevention measures have demonstrably reduced the early onset of alcohol, nicotine, and other drug use in some populations. This has contributed to a reduction in deaths and serious injuries resulting from drug related injuries and illnesses. These and other identifiable results have major economic implications.
Ethical Promotion and Patient Recruitment by Addiction Treatment Programs
For the purposes of this policy statement, an addiction treatment program is defined as an entity that claims to provide evaluation, treatment, or referral for substance-related and other addictive disorders.
Prescription Drug Monitoring Programs (PDMPs)
Prescription Drug Monitoring Programs (PDMPs) are statewide electronic databases that collect designated data from pharmacies and medical offices that dispense controlled substances in the state. PDMPs are maintained at the state level and housed in various statewide regulatory, administrative, or law enforcement agencies.
Role of Recovery in Addiction Care
ASAM recognizes that, just as there are many contributing factors to addiction, there are many contributing factors to any one individual’s recovery. In this context, ASAM has based its definition of recovery, as delineated in the statement “Terminology Related to Addiction, Treatment, and Recovery”, on current knowledge and approaches, informed in large part by decades of experience of people living with addiction.
Regulation of Office-Based Opioid Treatment
The initial model of office-based opioid treatment using methadone was first devised as a pathway to expand the reach and capacity of methadone treatment in the 1980’s.1,2 In the United States today, the most common type of OBOT uses the partial opioid agonist buprenorphine and was made possible by the Drug Addiction Treatment Act of 2000 (DATA 2000).