Physicians take steps to address opioid overdose epidemic

The physician role in reducing opioid medication misuse, overdose and death is an important one. Several new policies were put into place by physician delegates at the 2016 AMA Annual Meeting addressing factors that are critical  to reversing the epidemic, including prescription drug monitoring programs (PDMP), access to naloxone and addiction medicine as a sub-specialty.

The prevention and treatment of opioid use disorder has been a focus of the AMA’s Task Force to Reduce Prescription Opioid Abuse since its inception. PDMPs are important tools that physicians have to help them in this effort.

Not all states allow physicians to access their own prescription records, which would provide better control against fraudulent prescribing. Physicians adopted policy to promote the efforts for state-run electronic PDMPs that allow individual physicians to access their opioid prescribing records for their entire panel of patients, including patient names and prescription information.

New policy also asks that the AMA study current pathways that may allow physicians to report possible fraudulent use of their prescriptions.

There has been a large increase in naloxone dispensed over the past 18 months, a report from the AMA Board of Trustees stated. From the fourth quarter of 2014 to the second quarter of 2015, there was a 1,170 percent increase. This life-saving opioid overdose antidote is an important tool for physicians to minimize harm when treating at-risk patients with opioid medications.

In response to the report, delegates at the 2016 AMA Annual Meeting adopted policy to:

• Support legislative and regulatory efforts that increase access to naloxone, including collaborative practice agreements with pharmacists and standing orders for pharmacies as well as community-based organizations, law enforcement agencies, correctional settings, schools, and other locations that do not restrict the route or administration for naloxone delivery.
• Support efforts that enable law enforcement agencies to carry and administer naloxone.
• Encourage physicians to co-prescribe naloxone to patients at risk of overdose and, where permitted by law, to the friends and family members of such patients.
• Encourage private and public payers to include all forms of naloxone on their preferred drug lists and formularies with minimal or no cost sharing.
• Support liability protections for physicians and other health care professionals and others who are authorized to prescribe, dispense or administer naloxone pursuant to state law.
• Support efforts to encourage individuals who are authorized to administer naloxone to receive appropriate education to enable them to do so effectively.

Although intended to promote pain assessment and effective treatment, notion of “pain as the fifth vital sign” and the evolution of patient satisfaction surveys that include a focus on the extent to which a patient’s pain is relieved has created a practice environment that likely contributed to an increase in opioid prescriptions, according to a report from the AMA Board of Trustees.

Despite the substantial burden of persistent pain in the U.S., access to multidisciplinary care and insurance coverage for non-pharmacologic approaches is woefully inadequate, according to the report. These factors also have contributed to the routine use of opioid analgesics.

Measuring adequate pain control in acute and subacute care settings is complicated by the subjective nature of pain intensity reports by patients. Delegates adopted policies intended to promote access to high quality, comprehensive pain care, including:

• Work with The Joint Commission to promote evidence-based, functional and effective pain assessment and treatment measures for accreditation standards.
• Support timely and appropriate access to non-opioid and non-pharmacologic treatments for pain, including removing barriers to such treatments when they inhibit a patient’s access to care.
• Advocate for the removal of the pain management component of patient satisfaction surveys as it pertains to payment and quality metrics.

Delegates also adopted policy supporting the American Board of Preventive Medicine’s (ABPM) establishment of addiction medicine as a subspecialty for physicians. The new policy also encourages ABPM to offer its first American Board of Medical Specialties-approved certification examination in addiction medicine expeditiously in order to improve access to care to treat addiction.

“We applaud the American Board of Preventive Medicine for making addiction medicine a new subspecialty,” AMA Board Member Patrice A. Harris, MD, said. “We believe that having more physicians specifically trained to treat addiction will help improve access to care and help combat the nation’s opioid epidemic.”

Delegates also instructed the AMA to work with the Centers for Disease Control and Prevention (CDC) and other regulatory agencies to have long-term care facilities viewed as exempt from the recommendations contained in new guidelines from the CDC for the use of opioid medications for chronic pain, in much the same way as is being done for hospice and palliative care.

The AMA Task Force to Reduce Prescription Opioid Abuse has established five recommendations for physicians to combat the opioid overdose epidemic. These recommendations include: Register for and use your state PDMP to check your patient’s prescription history; educate yourself on managing pain and promoting safe, responsible opioid prescribing; support overdose prevention measures, such as increased access to naloxone; reduce the stigma of substance use disorder and enhance access to treatment; and ensure patients in pain aren’t stigmatized and can receive comprehensive treatment.

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