Alternatives to Opioids:

Expanding Nonpharmacological Treatment via Opioid Settlement Funding

(A template presentation for allies and advocates. Please make edits to this document to aid in your organization’s internal or preliminary discussions.)

​

​

Primary Source: RAND Corporation publication Alternatives to Opioids: A Missing Piece of the Strategy

Additional information: nwhealth.edu/fundNPT

Background

• Opioid related lawsuits are expected to generate more than $50 billion in settlement funds.
• This money will be allocated to states and localities to remediate the consequences of the ongoing opioid epidemic.

Pain remains a precursor to opioid use

• Pain remains a top reason for patients seeking medical care and leading medical condition for receiving an opioid prescription.
• Although the rate of prescription opioids is decreasing, they continue to be inappropriately prescribed for non-cancer pain and despite evidence of limited effectiveness.

​

​

Guidelines for Pain

• Current guidelines recommend meditation, acupuncture, massage therapy, and spinal manipulation as evidence-based, nonopioid treatments for both acute and chronic pain.
• Guidelines from the CDC are among the many contemporary systematic reviews and clinical guidelines that overwhelmingly recommend a trial of NPT for acute and chronic pain management prior to opioid initiation.
• Expanding use of these “nonpharmacologic therapies” or “NPTs” should be a priority for policy makers.�

A Gap in Access

• Policies that restrict opioid prescribing are insufficient on their own; providing accessible, effective alternatives for pain management are also required.
• Reductions in opioid prescribing have outpaced increases in the availability and accessibility of nonopioid and nonpharmacological pain treatment, creating a gap in pain relief.

�

Opioid Settlement Fund

• The $50+ billion opioid settlement fund is intended to be used for direct investments that save and improve individuals’ lives.
• Specifically included within this settlement is nonopioid treatments for pain.
• RAND Corporation, a leading public policy thinktank, released recommendations outlining how the settlement funds can be used to increase use of nonpharmacologic therapies.

​

Recommendation

• Increase Awareness of Nonpharmacological Therapy Use for Pain

Increase Awareness of Nonpharmacological Therapy Use for Pain

• Given that pain will affect all people at some time during their life, a greater societal understanding of the benefits of NPTs and supporting evidence is necessary.
• Examples:
• Healthcare summits
• Public service announcements

​

​

Recommendation

• Expand Coverage of Nonpharmacological Therapies, Especially Under Medicaid

Expand Coverage of Nonpharmacological Therapies, Especially Under Medicaid

• Given that many state Medicaid programs have limited coverage of NPTs, state leaders should direct settlement funding to cover NPTs.
• Examples:
• Medicaid state plan amendment
• Federal waiver authority
• Eliminate copayments via insurance regulation

Recommendation

• Enhance Equity of Access, Including Through Community-Informed Access

Enhance Equity of Access, Including Through Community-Informed Access

• At all jurisdictional levels, those responsible for allocating settlement funds should prioritize improving pain management programs, research, and care delivery for underserved populations.
• Examples
• Direct funding of NPTs within:
• Federal Qualified Health Centers
• Community-based health clinics
• Health clinics on tribal lands
• Fund needs assessments on implementation

​

Recommendation

• Support Nonclinical, Nonpharmacological Therapy Interventions for Pain Management

Support Nonclinical, Nonpharmacological Therapy Interventions for Pain Management

• Decisionmakers at all jurisdictional levels should consider increasing access to evidence-based therapeutic interventions that address pain and reinforce opioid misuse recovery.
• Examples
• Therapies include: Mind-body, yoga, tai chi
• These therapies could be provided at local health departments, community fitness centers, public schools
• Technological innovations could facilitate use

Recommendation

• Reduce Barriers to Accessing Provider-Led Nonpharmacological Therapies

Reduce Barriers to Accessing Provider-Led Nonpharmacological Therapies

• Decisionmakers who are responsible for managing settlement funding should direct funds toward supporting analyses of the ability of pain patients to access NPTs. They should also allocate additional funding to support specific corrections to expand access to NPT.
• Examples
• Enact and enforce policy that eliminate copayments and arbitrary limits on NPTs
• Create grants and fund student loan forgiveness to incentivize NPT in underserved communities
• Provide transportation to facilitate adherence to NPT visits

Recommendation

• Fund Pilot Projects That Integrate Nonpharmacological Therapy into Opioid Use Disorder Treatment Programs

Fund Pilot Projects That Integrate Nonpharmacological Therapy into OUD Treatment Programs

• Where possible, decisionmakers settlement funding should consider funding innovative initiatives that integrate NPT alongside OUD medical treatment and mental or behavioral health programs for substance abuse rehabilitation.
• Examples
• Directly integrating NPT alongside:
• Inpatient and outpatient OUD care
• Behavioral care rehabilitation
• Collaborative care models

Recommendation

• Build Infrastructure to Facilitate Nonpharmacological Therapy Use

Build Infrastructure to Facilitate Nonpharmacological Therapy Use

• As states and health networks make other investments in health technology and informatics, settlement funds should be used to supplement these investments’ capacity to reduce the use of unnecessary opioids for the treatment of common pain disorders.
• Examples
• Re-design clinical care pathways
• Creation of physician nudges to reduce opioid prescription
• Direct referrals to high-value NPTs

Applying for funding

Application Process

• The distribution of money is locally decided, in most cases by a council or committee composed of local stakeholders including elected officials, providers, patients, and others.
• The dispersal of funding is not uniform between cities and states, meaning it is critical that applicants investigate the local needs and local pathways as a means to acquire funding.
• Oftentimes this will require an application or submission in response to a request for proposals.

Strategies to Support Application

• Research your local settlement process, including application timelines and who is involved with approval.
• Build allies and collaborators, where possible.
• Connect with members of the opioid settlement committee.
• Partner with state agencies or the state legislature if necessary to change laws/regulations.

​

• Utilize resources found at nwhealth.edu/fundNPT

Conclusion

The opioid settlement fund contains an opportunity to re-engineer how the current healthcare system could direct patients away from opioid use and towards NPTs.

​

It is up to organizations and individuals to leverage their relationships and efforts towards expanding access of NPT within their communities.

​

Stay connected and read more information at nwhealth.edu/fundNPT