In light of the coronavirus disease (COVID-19) pandemic, the American Medical Association (AMA) has released policy recommendations to help meet the needs of patients with opioid use disorder (OUD) and chronic pain. The recommendations aim to sustain “harm reduction efforts in communities across the United States.”
First, the AMA called for medications used in the treatment of addiction, including buprenorphine and methadone, as well as treatments for overdoses such as naloxone, to be deemed essential services to ensure that patients with OUD continue to have access to care. This designation can improve access to crucial medications that may be difficult to obtain in cities with formal shelter-in-place or quarantine orders.
The AMA also called for alterations for insurers, including the termination of cost-sharing and prior authorization for these medications and removing restrictions on Medicaid preferred drug lists. They also suggested that criminal justice measures, such as drug testing, counseling, and reporting requirements, be curtailed to ensure that patients do not lose public benefits or become incarcerated, especially considering mounting fears of COVID-19 spread in the prison system.
Second, the AMA urged policymakers to increase protections for patients with pain disorders by waiving limits on prescriptions for controlled substances. These measures would allow fewer limitations on doses, quantities, refills, and electronic prescribing. For patients with chronic pain, they suggested waiving testing and in-person counseling requirements for refills, allowing consultation via telephone, and offering home delivery options for medications. These changes aim to support patients with OUD by removing possible obstacles to care created by the COVID-19 outbreak.
Finally, the AMA raised the question of harm reduction. To prevent overdoses and quell the spread of infectious disease, the AMA proposed that policymakers reduce barriers to accessing critical supplies by designating harm reduction organizations as essential services. They also advocated for assistance designated for harm reduction organizations to maintain adequate availability of naloxone in affected communities.
Furthermore, the AMA suggested the expansion of personal protective equipment (PPE) priority to include harm reduction and community organizations for drug injections. These syringe services programs “help protect against the spread of infectious disease,” according to the AMA.
American Medical Association. COVID-19 policy recommendations for OUD, pain, harm reduction. Updated March 26, 2020. www.ama-assn.org/delivering-care/public-health/covid-19-policy-recommendations-oud-pain-harm-reduction. Accessed April 1, 2020.