Policy reforms, increased funding would do much to fight addiction

TREATMENT

As we all know far too well, the crisis surrounding substance use and mental health in New Hampshire and across the nation has significantly worsened over the past year, with the coronavirus pandemic creating more loneliness and despair, more substance use, and more barriers for those seeking treatment. Following promising news that the 2018 overdose death rate declined for the first time in decades, last year’s rate was the worst in U.S. history. The pandemic has led to increased risk factors for depression, suicide and addiction, along with spikes in anxiety and trauma, all of which have contributed to higher rates of substance use in our communities.

But there is reason for hope in the form of new federal legislation that proposes to extend the 2016 Comprehensive Addiction and Recovery Act (CARA) that was signed into law by former President Obama. CARA 2.0, sponsored by U.S. Sens. Rob Portman (R-Ohio), Sheldon Whitehouse (D-R.I.) and Amy Klobuchar (D-Minn.), promises to make much-needed progress in the battle against opioid addiction through policy reforms and increased funding.

Better Life Partners is a physicianled organization based in Hanover and serving members across New Hampshire and Vermont. We are a leading provider of medication-assisted treatment (MAT) for opioid use disorder, providing effective, accessible and highquality medical and behavioral health care and care coordination. We work primarily with under-served populations and communities, with nearly 90% of our members uninsured or covered by Medicare or Medicaid. Since our founding in 2018, our mission has been to help any underserved individual achieve a healthier life filled with belonging, love and purpose.

CARA 2.0 would help like-minded organizations continue delivering effective, evidence-based care in ways that work best for our members.

Seeing the urgent need for remote care at the onset of the pandemic, community organizations and treatment providers rapidly shifted to remote services and have thus increased access to timely and necessary care. CARA 2.0 would preserve these essential options, enabling providers to prescribe and manage care remotely and be reimbursed for telehealth services.

CARA 2.0 would also ease limits on the number of patients a medical provider can treat using life-saving medications like buprenorphine. Recent research has found that this change would result in expanded access for patients and less stigma about seeking treatment, improving outcomes for patients and our communities. The change would especially benefit the under-served rural areas that have been particularly hard-hit by the opioid epidemic.

A 2019 review of treatment availability published in the Journal of Rural Health found that more than half of all rural counties in the U.S. still lacked a single buprenorphine prescriber. CARA 2.0 would help address this challenge by reducing barriers to entry for providers and allowing rural physicians to serve more patients who need life-saving treatment.

Finally, CARA 2.0 makes policy changes that can help address the root causes of this devastating health crisis. The bill sets a three-day limit on initial opioid prescriptions for acute pain, as recommended by the CDC, and mandates physician education on addiction, treatment and pain management. It also provides funding for public education on the dangers of opioid misuse, heroin and lethal fentanyl, and funds research into non-opioid pain management alternatives.

It’s clearer than ever that we need targeted interventions to address our country’s devastating and deadly substance use epidemic.

Our elected officials in New Hampshire and Vermont have been active supporters of CARA 2.0 and prior legislation supporting access to treatment.

We at Better Life Partners urge lawmakers across the country to advance this important bill to help prevent opioid addiction and increase access to treatment. Once passed, we’d like to see our state legislature follow suit and pass legislation that aligns with the federal standards.

Dr. David de Gijsel is medical director at Better Life Partners, Assistant Professor of medicine at the Geisel School of Medicine and a physician in the Section of Infectious Disease at Dartmouth-Hitchcock Medical Center.