Substance Use Guidelines Focus on Evidence-Based Care

By Cari Wade Gervin
Wednesday, February 2, 2022

New AMA Substance Use & Pain Care Task Force recommendations aim to improve opioid prescribing and addiction treatment.

In September 2021, the AMA released guidelines from its new Substance Use and Pain Care Task Force intended to help providers better prescribe opioids and treat pain and substance use disorder (SUD). Crafted over several years with input from 28 other organizations, the guidelines focus on evidence-based care that avoids stigma and one-size-fits-all treatments.

“Physicians must continue to lead by example to help our patients with pain, SUDs and mental illness,” says Bobby Mukkamala, MD, AMA Board Chair and chair of the task force. “Removing barriers requires policymakers to join us in establishing a more effective and humane approach. Failure to adopt these policies will prolong the epidemic and our patients’ suffering.”

The Big Takeaways

The task force released five recommendations:

  • Support patients with pain, mental illness or SUD by building an evidence-based and resilient infrastructure rather than continuing a crisis-driven approach.
  • Remove barriers to evidence-based treatment for SUDs, co-occurring mental illness and pain, including the barriers faced by people incarcerated or on parole.
  • Improve insurance coverage and other financial access to multidisciplinary, multimodal evidence-based treatment.
  • Broaden public health and harm reduction strategies to save lives, such as needle exchanges and naloxone access.
  • Improve stakeholder and multi-sector collaboration in an effort to ensure that everyone benefits from evidence-based decisions.

The Work Ahead

One of the biggest hurdles to successfully implementing the guidelines in practice is improving education around pain management and SUD. Physicians who do not practice addiction medicine may not be aware of the latest research supporting medication-assisted treatment (MAT), for example. And stakeholders such as legislators, sheriffs or judges may still be convinced addiction is a moral failing that deserves harsh punishment.

“It’s really unfortunate that so many policymakers do not understand the facts surrounding substance use disorders,” Dr. Mukkamala says. “Often talking to local leaders can make a difference, like helping educate your mayor or sheriff about the need for safe detox and MAT in jails.”

Physicians who do not have a current understanding of addiction medicine or pain management best practices to prevent addiction can take continuing education courses to improve their knowledge and better help inform their practice. Others may find it helpful to lobby for changes in state legislation to make treatment more accessible and affordable.

“Many organizations, including the AMA, have started to look at issues of health using the lens of equity to assess where we can improve,” Dr. Mukkamala says. “Substance use disorder and pain care are issues that definitely benefit from looking with this lens. When policymakers adopt our recommendations, they will be improving health equity.”