More funding for research on opioid addiction and improved prevention and treatment programs are among psychologists' advocacy priorities at the federal, state and local levels.
At the federal level, advocates have won some major successes, including the launch of the National Institutes of Health's HEAL (Helping to End Addiction Long-term) initiative. The effort, which incorporates psychological approaches into its research plan, has nearly doubled funding for pain and opioid research, from $600 million to $1.1 billion, over two years. Advocates also secured expanded access to treatment, thanks to the enactment of the SUPPORT (Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment) for Patients and Communities Act last fall. The SUPPORT Act requires state Medicaid programs to cover methadone and all other medications used to treat opioid use disorder beginning in 2020 and expands Medicare coverage to include telehealth services for substance use disorders. It also requires the Centers for Medicare and Medicaid Services to develop guidelines on non-opioid pain management for participating hospitals and state Medicaid programs. And it authorizes a demonstration project aimed at increasing the number of substance use treatment providers through improved reimbursement rates and training.
Psychologists can play a key role in implementing the new law and making sure it fulfills its potential (see How you can get involved), says Nancy Piotrowski, PhD, federal advocacy coordinator for APA's Div. 50 (Society of Addiction Psychology). "There are lots of opportunities for psychologists to establish lines of funding for research, training and clinical services that address some of the systemic gaps that have existed in the health-care system," says Piotrowski. These new funding streams and programs also create opportunities for psychologists to use their skills in translating research findings for use in real-life settings and in evaluating outcomes.
APA has also been successful in nominating psychologists to serve in advisory roles in federal groups addressing the opioid epidemic and related issues. Mary Meagher, PhD, of Texas A&M University is now a member of the federal Pain Management Best Practices Inter-agency Task Force, which will develop recommendations for better addressing acute and chronic pain, for example. APA also provided input to the President's Commission on Combating Drug Addiction and the Opioid Crisis.
Meanwhile, raising awareness of the issue of substance use disorders among members of Congress and their staffs is a key priority for researcher Sandra Comer, PhD, public policy officer for the College on Problems of Drug Dependence, an organization for scientists focused on understanding addictive disorders and finding new treatments for them.
"They often don't have a clear understanding of what substance users face and what challenges they have," says Comer, a research scientist at the New York State Psychiatric Institute and professor of neurobiology at Columbia University.
Another priority is convincing legislators to remove cumbersome barriers for researchers who study drugs of abuse. For example, last year the Drug Enforcement Agency changed the classification of illicit fentanyl analogues—which, unlike fentanyl itself, have no known medical use—to Schedule 1. While this action was appropriate for protecting public health, says Comer, it makes it more difficult for scientists to study these compounds. "That's a problem because it is critical that we understand the pharmacology of these drugs," says Comer. "We're trying to figure out more streamlined ways for scientists to do the research while at the same time ensuring proper controls on these substances."
Research with nonhuman primates is also critical, Comer told policymakers and staff at a congressional briefing APA co-sponsored with the Supporting Truth About Animal Research Coalition in March. "The Food and Drug Administration would never in a million years allow me to give synthetic fentanyl to human research volunteers," says Comer. "To understand how these drugs work, we have to rely on preclinical research."
At another congressional briefing sponsored by the Patient-Centered Outcomes Research Institute, psychologist Beth Darnall, PhD, a clinical professor of anesthesiology, perioperative and pain medicine at Stanford University School of Medicine, focused on what she calls "the dual crises of pain and opioids in America." Darnall described her research, which uses behavioral treatments to help pain patients taper their opioid use.
Other psychologists are advocating for change at the state level. In Connecticut, Traci Cipriano, JD, PhD, is taking several approaches in her advocacy. In addition to educating psychologists and physicians, she is working to ensure that the state's workers' compensation system follows its protocols for both medical and psychosocial treatments for chronic pain. Many physicians didn't know the protocols existed, says Cipriano, a private practitioner and an assistant clinical professor of psychiatry at Yale University School of Medicine, who is an adviser to the state's Workers' Compensation Commission. "My work is trying to get the word out," she says. In addition, Cipriano is working with policymakers, insurers and the Connecticut State Medical Society to explore policy options to improve interdisciplinary care for patients with opioid use disorder in ways that also reduce costs.
In Maryland, Carlo DiClemente, PhD, ABPP, a professor emeritus of psychology at the University of Maryland, Baltimore County, is among those urging the governor's Opioid Operational Command Center to distribute naloxone for treating overdoses and incorporate other harm-reduction strategies, such as offering clean needles.
Collaborating with other health-care professionals at the state level is key, says Paul Korte, PhD, the Missouri Psychological Association's federal advocacy coordinator. The association is working with physician groups and others to urge legislators to enact a statewide prescription drug monitoring program to help reduce misuse of drugs. "Missouri is the only state in the union that still doesn't have one," says Korte, explaining that such programs help prevent "doctor-shopping" by those seeking inappropriate access to drugs. "It's just one more tool to help control prescription opioids," says Korte.
Access to health care more broadly is another priority in the states. The Ohio Psychological Association, for example, is fighting to protect the state's Medicaid expansion, which now covers almost 630,000 of the state's most vulnerable residents, including those with substance use problems. "For many of them, it's the first time they've had coverage of any type," says Michael Ranney, the association's CEO.
At a more local level, Aaron Weiner, PhD, ABPP, is advocating for change within Linden Oaks Behavioral Health, part of Edward-Elmhurst Health, a large integrated health-care system in Illinois, where he is director of addiction services. By tracking opioid prescriptions, he found that physicians were overprescribing the drugs and that surgeons weren't customizing prescriptions. "I had one surgeon say, 'Whether it's a hip or a knee, a 110-pound woman or a 300-pound man, I give 160 tablets of narcotics post-operatively,'" says Weiner.
To ensure that physicians are writing prescriptions only for those who truly need opioids, Weiner worked with two dozen physicians to develop prescribing guidelines, drawing on those of the Centers for Disease Control and Prevention.
"A lot of what's going on with the epidemic right now focuses on the demand side for opioids," says Weiner. "From a health-care perspective, we need to take a hard look at the supply side."
