http://www.asam.org/advocacy/find-a-policy-statement/view-policy-statement/public-policy-statements/2013/04/25/pharmacological-therapies-for-opioid-use-disorders

Key Components:

• Recommending patients have access to all pharmacotherapies in individualized treatment designed by physician
• Arbitrary Limits on treatment are detrimental to patients
• Arbitrary Limits on numbers of patients (X-DEA) limits should not be imposed by law
• Prior Auth requirements, co-pays etc. should be on par with chronic medical illness

http://www.asam.org/advocacy/find-a-policy-statement/view-policy-statement/public-policy-statements/2012/08/31/opioid-abuse-dependence-and-addiction-in-pregnancy-a-joint-opinion-of-acog-and-asam

Key Components:

• Early identification of dependency improves outcomes
• Contraceptive counseling is critical during treatment
• Treatment during pregnancy should be co-managed by OB and Addiction provider
• Avoid medically supervised withdrawal during pregnancy
• Monitor infants closely for NAS                    

http://www.asam.org/advocacy/find-a-policy-statement/view-policy-statement/public-policy-statements/2012/07/30/state-level-proposals-to-legalize-marijuana

Key Components:

• Marijuana use is neither safe nor harmless
• Detailed review of current state and non-U.S. legal status
• Substance use disorders resulting from marijuana are widespread
• Legalization could lead to young people viewing marijuana as less harmful
• ASAM recommends against approval of state initiatives to legalize

http://www.asam.org/advocacy/find-a-policy-statement/view-policy-statement/public-policy-statements/2011/12/15/the-definition-of-addiction

Key Components:

• Provides short and long definition of Addiction
• Describes Neurobiology of Addiction
• Characterizes common themes with Addiction including cognitive, behavioral and emotional changes
• Recommends recovery be achieved with self management, mutual support and professional care
• Defines goals of recovery over time

http://www.asam.org/advocacy/find-a-policy-statement/view-policy-statement/public-policy-statements/2011/12/15/use-of-naloxone-for-the-prevention-of-drug-overdose-deaths

Key Components:

• Pilot programs for distribution have been very successful both with first responders, and non-medical family members, companions
• Nasal naloxone is effective, fast acting, inexpensive ($0.27/dose) and non addictive
• Training should be provided to authorized dispensers
• States should broaden distribution for opioid overdose prevention
• Education is key to emphasize goal of saving lives over negative reactions to increased needle use, and other objections
• O/D prevention should be regarded as a gateway to long term opioid treatment

Multiple (12) policy statements all made 4/2011 regarding credentialing, evaluation, treatment, discrimination, impairment and public actions by state medical agencies for licensed professionals with addictive illness  (http://www.asam.org/advocacy/find-a-policy-statement/-in-Category/Categories/policy-statements/licensed-professionals-with-addictive-illness)

Key Components Individually reviewed include:

• Confidentiality in Healthcare for licensed professionals with impairing illness
• Coordination between treatment providers, health programs and regulatory agencies
• Credentialing in Healthcare for licensed professionals with addiction
• Discrimination and the addicted professional
• Evaluation, Treatment and Continuing care
• Over view of professionals with addictive illness
• Illness vs. impairment
• Public Actions by State medical licensure boards

I.  Nasal Naloxone Rescue Kits, distribution by Addiction providers:

1. Availability in pharmacies
2. Physician education (REMS)
3. Insurance coverage
4. Tapestry Health providing this service currently, ? Grant opportunities

II.  Obstetrician-Gynecologist providers of Addiction treatment:

1. Issue related to a “code set” deemed applicable/relevant to OB/Gyn physicians by insurers
2. Insurers will kick back any pairing of diagnosis codes for addiction with OB/Gyn physicians, is this is the case for surgeons as well?
3. ACOG is creating a position statement
4. OB/Gyn physicians commonly provide Primary care services in Women’s health arena
5. Need to educate insurers

III.  Probation, Criminal justice system and Treatment:

1. Statewide Probation systems/education for integrated referral/care
2. Upon Admission Inmates should be offered MAT
3. Prior to discharge, referral for integrated care (MAT and counseling)
4. Underutilization of Chapter 111E Drug Rehabilitation
   1. Condition of Probation
   2. Avoid Incarceration by placement in treatment
   3. Rewrite law so that inpatient treatment is not mandated
   4. Expand knowledge of this provision so Judges liberally use this initiative rather than refer for correctional placement
5. IM Naloxone for treatment prior to discharge
1. Insurance/Financial barriers
2. Administration/Transportation barriers

IV.  Mass Health and access to care with referrals required for patient access:

1. While Mass Health PCC plan indicates no referral needed for substance abuse, they continue to require referral by PCP to addiction physician seeing patient for MAT
2. No referral needed for behavioral health providers
3. BMC HealthNet and Be Healthy HNE plans do not require this referral
4. Limits access to care for patients who have PCC plan, without first obtaining PCP referral, many patients have never met PCP
5. Limits access to care for people discharged from Correctional system, all placed on Mass Health at time of discharge