Building on their 2019 “National Roadmap on State-Level Efforts to End the Opioid Epidemic: Leading-Edge Practices and Next Steps,” the American Medical Association (AMA) and Manatt Health have partnered to create a new policy roadmap identifying effective state-based policy solutions to combat the drug overdose epidemic.

The expanded “National Roadmap on State-Level Efforts to End the Nation’s Drug Overdose Epidemic” builds on our 2019 policy recommendations with summaries of what states have done to combat the epidemic and where more action is needed. The results are mixed, with the COVID-19 pandemic creating new challenges but also opening up new opportunities for state-level progress. For example, the important national focus on addressing racial inequities in care has exposed huge disparities in how different populations fare with respect to substance use disorders (SUDs), but also generated new support for addressing those disparities. The analysis provides recommendations to state insurance commissioners, Medicaid officials, governors, legislators, attorneys general and other policymakers, and highlights the need to directly address long-standing inequities in access to SUD treatment for Black Americans and other underrepresented communities.

Five key state policy themes emerged from this year’s report:

1. The “opioid epidemic” continues to evolve into a broader and more deadly drug overdose epidemic.
2. Inequitable access to care elevates risks for communities of color.
3. Mental health and SUD are linked, and treatment must be as well. 
4. Telehealth services are rapidly expanding due to the COVID-19 pandemic.
5. Incarcerated populations are overlooked.

In the national roadmap, Manatt Health and the AMA highlight six key areas where state regulators, policymakers and other stakeholders have taken action and examine which actions merit replication in other states. These six areas are as follows:

• Improving access to evidence-based treatment for opioid use disorder. Remove prior authorization and other barriers, including affordability, to medications to treat opioid use disorder and ensure that the full continuum of care is available to people with an SUD.
• Enforcing mental health and SUD parity laws. Increase meaningful oversight and enforcement of parity laws, including requiring payers to demonstrate compliance prospectively as part of the product approval process.
• Addressing network adequacy and enhancing the workforce. Ensure access to addiction medicine physicians, psychiatrists and other healthcare professionals.
• Expanding pain management options. Enhance access to comprehensive pain care, including multidisciplinary, multimodal care for patients with pain.
• Improving harm reduction efforts. Reduce harm by expanding access to the overdose-reversing drug naloxone and coordinating care for patients in crisis. Harm reduction also must include increased access to sterile needle and syringe services.
• Enhancing monitoring and evaluation. Implement programs that monitor and evaluate policies and outcomes to identify what is working, and then build on those successes.