Last year, I published a piece calling for federal action on the Alternatives to PAIN Act and applauding Senator Katie Britt’s leadership in cosponsoring this crucial legislation. While federal efforts remain vital for expanding coverage of non-opioids for all Seniors on Medicare, Alabama has an immediate opportunity to ensure access to non-opioid pain treatment options for members of our community now. Within the next few weeks, the state Medicaid program must decide how to cover non-opioid pain treatments, and this decision will determine whether we prevent addiction or watch preventable cases unfold.
The most recent data on Alabama’s opioid crisis tells a nuanced story: Alabama has made great progress in reducing opioid prescriptions from 97.5 per 100 persons in 2018 down to 71 per 100 people in 2023, according to the CDC, yet we still have the second-highest prescription rate in the nation. Meanwhile, in 2024, 794 overdose deaths in Alabama—67.5 percent of all overdose deaths—involved opioids. While we are moving in the right direction, we can and should do more: if we can continue reducing opioid prescriptions, we can further stem overdoses and addiction. As CEO of Inside Medicine, which works to bring together patients, doctors, and communities around better healthcare information, I have seen how empowering all three with newer, safer treatment options can transform outcomes. That is why the stakes of Alabama Medicaid’s upcoming coverage decision could not be higher.
Across the Southeast, many of our neighboring states have already adopted policies that reduce the number of opioids prescribed. Louisiana, Tennessee, Florida, Georgia, and South Carolina have implemented “parity access”—ensuring that patients can receive non-opioid pain treatments without jumping through bureaucratic hoops. These states recognize that preventing addiction is infinitely better, cheaper, and easier than treating it after it develops. They understood that government works best when it removes barriers to good healthcare decisions rather than creating them.
The economics are also compelling. Every dollar spent removing barriers to non-opioid treatments returns exponentially more in avoided addiction treatment costs, emergency interventions, and long-term healthcare expenses.
On the other hand, if our Medicaid program chooses to require prior authorization for non-opioid treatments, it will create a system that pushes vulnerable patients toward the very substances that have devastated our communities. Under prior authorization, patients recovering from surgery or injury face a cruel dilemma: immediate access to opioids or prolonged suffering while waiting for bureaucratic approval of safer pain management options. The FDA has approved non-opioid treatments whose testing indicates they are as effective at treating acute pain as opioids, yet prior authorization policies make the dangerous option the easy option and the safe option the difficult one. This backwards incentive structure defies both medical evidence and common sense.
Given this counterproductive framework, Alabama Medicaid officials face a clear choice. They can follow the lead of our neighboring states and implement parity access, ensuring that non-opioid treatments are as accessible as opioids from the moment patients need them. Or they can choose prior authorization requirements that will inevitably push more Alabamians toward addiction.
Alabamians are counting on leaders who prioritize prevention over bureaucracy and long-term wellbeing over short-term administrative ease. The fact that so many neighboring states have chosen parity access speaks to their recognition of the devastation the opioid crisis has brought to communities and state economies—any opportunity to prevent some of that destruction is worth pursuing. The only question remaining is whether Alabama will choose to lead or lag in protecting our citizens from preventable addiction.
