The AMA’s five recommendations for combating opioid abuse

  | July 6, 2016

The nationwide opioid epidemic has left physicians, law enforcement, and state governments scrambling to discover solutions. And the American Medical Association is rallying physicians to step up and become leaders by confronting the issue head-on.

In May, the AMA’s chief executive officer, Steven Stack M.D., sent a letter urging physicians to take action in the face of the public health crisis.

Patrice Harris AMANot long afterward, Patrice Harris M.D., an Atlanta-based psychiatrist and chair of the AMA’s Taskforce to Reduce Opioid Abuse, spoke with athenaInsight about the AMA’s call to action.

How extensive is the opioid problem in the United States?

It is a public health epidemic, with over 250,000 lives lost between 1999 and 2014. This is an unacceptable epidemic, and it is the reason the AMA convened this task force.

Why did the AMA take these actions now?

The Board knew that physicians and health care leaders were working on this issue, and wanted to bring together a task force to amplify the effort and stem this tide. The task force is made up of 25 state and national medical societies and the American Dental Association. We knew lots of work was being done already but we wanted to learn from one another, learn from current work being done, and also come together to recommend policy.

What are some of those recommendations?

We have five main recommendations. One, we encourage physicians to use state prescription drug monitoring programs more fully. PDMPs are not a magic bullet or panacea, and they often need additional funding, but we still think they can be an important tool for physicians in their clinical decision-making regarding best treatment options for patients.

Second is to enhance training and education on pain management. Three, increase access to substance abuse disorder treatment, particularly prescription medication abuse. Four, increase access to Naloxone, and consider co-prescribing Naloxone for patients at higher risk of overdose.

Last is to address issues regarding stigma. I am psychiatrist, and I know first hand the stigma associated with mental disorders. We want a call to action to raise awareness to substance abuse and those dealing with chronic pain.

How has your message been received?

There has been a great reception. There is no one-size-fits-all solution, and the AMA encourages state-based solutions, because each state's laws and populations are different.

We have also pledged to work with other stakeholders to reduce these trends. It is important to have a comprehensive approach. There is a role for many — the governors, Congress, state legislators, insurers and other payers, pharmacy and the public.

Why did you say that physicians must "take responsibility" in the problem?

We believe physicians have always taken responsibility in medical decision-making. We want to amplify our efforts. This represents a recommitment to leadership. As I often say to those toiling at the front lines, this is an opportunity to show what is really going on.

How will you measure success in these initiatives?

We are tracking registrations for PDMPs. We want to increase the number of physicians who co-prescribe Naloxone. We are tracking the number of prescriptions, but I always emphasize that the number of prescriptions is an important data point but not the only data point. All treatment decisions are between the physician and the patient. At the end of the day, physicians use evidence-based treatments and research that is appropriate for the patient sitting in front of them. We all have to make the best treatment decisions at that time.

As we implement these regulations, we also need to track and mitigate unintended consequences. I recently saw a letter to the editor in a Charleston newspaper regarding pain management. The writer is a patient with chronic pain, and she is worried some of the new regulations may decrease her access to opioids. Of course opioids, are appropriate in certain situations, and it is only the misuse of opioids we are concerned with. So that would be an unintended consequence, and we certainly do not want that.

I want to reiterate that physicians across the country, among all specialties, are demonstrating leadership. And the conversation has to continue. We need everyone working on this issue. This is just the beginning.

This interview was condensed and edited. David Levine is a contributing writer based in Albany, NY

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Regarding this article’s 2nd to last paragraph: It’s unconscionable the way Patrice Harris so casually almost dismisses the patients who legitimately need opioids. We are not ‘unintended consequences’ – it’s the abusers who are, and I’m sick of being blamed and paying the price with my continued pain for their: 1) need to get a buzz, 2) lack of self-control, and/or 3) genetic proclivity to addiction. I just participated in an opioid pain study with 8 other people who are suffering terribly because these unfeeling government lackeys have no idea what we go through every day. It was clear from the interviews we did that NONE of us are abusers, and have a real need for pain mitigation. My doctors are hamstrung by obscene regulations that cause now-apparently-irreparable suffering to millions of us. My government is supposed to protect ME, too! IF there’s an ‘opioid epidemic’ – flamingly fostered by the media, too – then take measures to fix THOSE people, not ME. Ms. Harris’s ‘5 recommendations’ do nothing to help non-abusers; in fact, they force us to live in continued, unrelenting pain. She’s skewing the ‘non-abuser’ to ‘abuser’ ratio in favor of the abusers, who are far fewer in numbers than the non-abusers. Restricting my access to opioids – along with the millions who truly need them – is denying us our constitutional rights. Denying alternative therapies payments thru ACA or Medicare/Medicaid needs to stop – as only one example, massage therapy works for some of us, but is not covered by any health insurance plans that I know of. Science will one day come up with truly effective opioid alternatives but, until then, opioids are our ONLY choice. The government right now in this sphere IS the ‘monkey on my back.’

Name: 
Jan Sloat
Email: 
test@test.com

WOW, you are so RIGHT.. As a veteran I was sat down by 3 Pain Team chicks..and questioned for an hour, then they instantly reduced my morphine low dose which I HAD tapered down on over a year to immediate 50% fewer in just 14 days to next refill..with NO F***& advice on HOW to do that so fast…just a bottle of anti nausea,anti diarrhea and 10 Colondine..and ARGUED with me on needing more as I fast tapered MYSELF with no help as not to be stuck in 2 weeks with NO choice but one a day. and really suffer all at once with a PAST Stroke, I can’t do that!…..so by adding an hour each few days I still wound up not sleeping as I went past the body’s expected dose time… RLS, stomach upset, malaise, headaches, NO sleep over and over the last 8 days as I reached 23 hours was utter misery… yet when I asked for Clonodine again ( a non restricted BP med) to help sleep (makes me groggy) they lectured/argued on temporary use of it…but had given NO instruction on any of that!!! Don’t they TRAIN to teach us? The “psychologist team member” will be talking to me LONG AFTER this, when I need far less help…. So I just contacted them “frequently” to “share my pain” until they’re just as annoyed as me…yes you should be! Vets should fight back, insist on tapering advice and longer time to safer taper..

Name: 
PissedOff Veteran
Email: 
test@test.com

I also am a chronic intractable pain patient and I am so tired of being looked at like a drug seeker or addict. The mass majority of chronic pain patients do not become addicted to opiates long before they do they become immune to them. We do not get the euphoric feeling that acute pain patients and addicts do and seek. With all the new supposed “Guidelines” etc we are the ones suffering and you the government and the different departments {DEA CDC etc} are the ones making so many of us turn to the street to get what we hope is not poison and or causing the suicide rate to rise amongst chronic pain patients. Most of us have been on different opiates for many years as it is the only thing that helps our pain to a degree where we can have some sembalance of a normal life. Now it is literally being taken away and we are expected to live our lives in excruciating pain. Where are rights as human beings? You are taking them all away and because of it you WILL have the blood of many deaths on your hands.

Name: 
Susan McKee
Email: 
test@test.com

You guys should feel sorry for the people who have both chronic pain and addiction. These people were in the positions you were in long before and doctors kept prescribing these synthetic heroin pills and now they’ve got a much worse problem than pain. You guys should talk to some people in NA…they’ve got screws and plates in their backs and they can’t take anything but motrin and neurontin and use heat pads bc they will probably die if they didn’t. Self control and a physical and mental addiction are two entirely separate concepts and the fact that you’re on here whining about getting your drugs reduced is your own form of dependency.

Name: 
Sara
Email: 
test@test.com

STOP THE STIGMA!! The big problem is government officials and insurance companies are impairing medical personnel from properly treating legitimate chronic pain sufferers. NO ONE chooses to be in pain most or every day of their lives. Most chronic pain patients are more than willing to put into practice whatever modality will alleviate or at least make daily pain tolerable. The question that must be asked is this, “Does every person who finds it necessary for living their NORMAL every day life by taking an opioid medication a drug addict or abuser?” Answer: NO! Not everyone who takes opioids becomes addicted. With proper education and trust, physicians and patients can certainly work together with the plan of care that works best for that patient. There is no “one size fits all” treatment that is going to be beneficial for everyone. And that’s just it, we are all individual! To whom it may concern, let the responsible doctors practice medicine fairly for people who deserve it. When patients are treated like criminals it’s understandable why some feel it necessary to find other alternatives for their condition. This is where problems begin. When forced to treat themselves people end up getting in over their heads and here is where it gets dangerous.

Name: 
Kim Payne
Email: 
test@test.com

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The AMA’s five recommendations for combating opioid abuse