Opioid-related lawsuits are expected to generate more than $50 billion nationwide in settlement funds for states and localities to remediate the catastrophic consequences of the opioid crisis.
Recently, RAND Corporation published a set of recommendations outlining how a portion of these funds should be used to fund improvements in the delivery of nonpharmacologic treatments (NPT), including chiropractic services, for individuals in pain. To accompany the recommendations, Northwestern Health Sciences University produced a Toolkit to assist advocates and organizations. This toolkit aims to outline more about the recommendations, the process to apply for local funding, and supportive strategies to secure settlement funding for initiatives that increase patient access to NPT.
The ACA Blog connected with authors of these projects, Drs Michele Maiers and Ryan Burdick, to discuss the initiative. (Both projects were funded through generous support from the NCMIC Foundation.)
Editor’s Note: Drs. Maiers and Burdick will make a presentation about the opioid recommendations and toolkit at ACA’s annual meeting in January, ACA Engage 2024. Register here.
Briefly, what are some of the strategies you recommend in the RAND paper to improve access to nonpharmacological therapies (NPTs) such as chiropractic services?
Drs. Maiers and Burdick: The recommendations are wide ranging and focus on many of the barriers patients experience when seeking chiropractic care. They also aim to transform how the general public, government insurers, private insurers, hospitals, and other healthcare providers view nonpharmacologic treatments. They include: improving public awareness of benefits of NPTs, improvements in public and private payments to NPT, directly funding provider-led and non-provider-led NPT, and investments in research and health innovations.
Can you give us a brief overview of where the opioid settlements are now? What is the timeline of their distributions?
Drs. Maiers and Burdick: Funds will be distributed to states, cities, regions, and tribal communities beginning in 2023 and continuing for an estimated 18 years. Each state and region has varying levels of funding and distribution plans. The Toolkit includes guidance for finding information in your region.
How are the funds distributed? Who exactly is making the plans in the states? Is it a particular agency or is it different everywhere?
Drs. Maiers and Burdick: Each state’s approaches to distribution varies. Some states have a higher percentage of the funds available for state spending. Other states intend to distribute most of the funding to local jurisdictions. As you explore opportunities, it’s important to investigate where the settlement funds are being distributed.
Some local funding may be provided to an individual city health department, whereas state funding may be under the control of a statewide committee of government officials, industry leaders, law enforcement, and medical providers. Often, these committees are open to the public and welcome stakeholder feedback.
You mention in the RAND paper that often settlement funds are being focused “downstream” to help manage patients already addicted to opioids or otherwise adversely affected rather than “upstream” strategies to prevent overuse and addiction. Why is prevention not being given more attention, considering 1 in 6 patients are still prescribed opioids against guideline recommendations?
Drs. Maiers and Burdick: The opioid crisis spans decades and impacts all communities across the country. It’s been characterized into three different waves: overprescription of opioids, rise of heroin use, and synthetic opioid use (e.g. fentanyl). It is critical that the country uses this $50+ billion fund to correct each wave, not just the most recent wave. Although opioid prescriptions have decreased, the rate of prescription opioids remains high relative to recommendations for appropriate use.
Moreover, many regions are operating in crisis mode, grappling with the devastating individual and societal impact of opioid misuse. But we’ll never get ahead of the issue if we don’t also emphasize effective strategies for preventing opioid initiation in the first place. A “both/and” strategy is needed to meaningfully change the trajectory of this epidemic.
Your paper makes a note of the historical lack of access and coverage of NPTs for people of color and other disadvantaged populations, such as those on tribal lands. What are some strategies that might improve the situation for these groups in particular?
Drs. Maiers and Burdick: As advocates and organizations aim to improve access to chiropractic in specific communities, it is critical to include these communities and their leaders in the conversation. Engaging stakeholders in conversation about their needs relative to non-opioid pain management, and how that can be integrated in a culturally agile way, is a critical first step to improving access to NPT in marginalized communities. Settlement funds could be used to embed NPT providers, like chiropractors, into Federally Qualified Health Centers or tribal clinics, establish pop-up or mobile care units, and promote health literacy in these communities.
What can front-line practicing chiropractors do to get involved in both a clinical and non-clinical capacity?
Drs. Maiers and Burdick: Most of the recommendations and strategies from the RAND policy paper and toolkit directly impact clinical providers. The toolkit was specifically designed to help translate this information and empower those with a clinical focus to make improvements at their local and state level.
Many ACA members are leaders not only within chiropractic organizations, but also leaders in their communities. To the extent each chiropractor is able, we recommend talking with other community stakeholders to understand local needs and gaps in access to NPT, and exploring what initiatives among those recommended in the RAND paper might be a good local solution. The toolkit has the information needed to help you then submit a proposal.
This is an incredible opportunity to actually pursue the projects and initiatives that many of us have long thought about doing in our communities. Funding is usually the hard part, but with the settlement fund, what is needed now is community leadership. ACA chiropractors are uniquely suited to lead.
Is there anything else you’d like chiropractors to know about the settlements at this time or what they can do to help bolster support for NPTs in the ongoing battle against opioid overuse and abuse?
Drs. Maiers and Burdick: This is an evolving process, and each state or region may have different needs, processes, and ideas. After you explore the recommendations and toolkit, please don’t hesitate to reach out via the toolkit website. We’d love to connect about specific issues or hear about your successes.
Outside of chiropractic, do you have any further suggestions on how ACA members can learn more on the opioid crisis?
Drs. Maiers and Burdick:
• Opioid Settlement Fund: There is a tracker of state level information found here.
• Books on opioid crisis: Dreamland: The True Tale of America’s Opioid Epidemic, by Sam Quinones; Empire of Pain, by Patrick Radden Keefe
• TV series: “Dopesick”; “Painkiller”
