Combating Prescription Drug Abuse and Diversion
Since 2005, the AMA, along with many other stakeholders in the health care community, has supported and helped secure passage of the National All Schedules Prescription Electronic Reporting Act (NASPER) as an essential tool in combating prescription drug abuse and diversion. Since then, the sense of urgency has only increased and the AMA continues to work on a number of fronts to combat diversion and drug abuse while at the same time preserving access to medically necessary treatment for pain.
The AMA supports:
- Full funding and staffing for up-to-date, interoperable, at the point-of-care prescription drug monitoring programs that are integrated into a physician’s workflow;
- State-based tools and resources that support identification and assessment of state-based addiction treatment gaps and appropriate targeting of funding and resources to expand access in concert with efforts to decrease the supply of diverted prescription drugs;
- Federal funding for a national framework to support accessible state-level take-back locations to remove unneeded prescription drugs including controlled substances from medicine cabinets;
- Positive incentives to promote physician education that provides current best prescribing practices and is tailored to meet a physician’s practice/patient population needs;
- Enforcement actions to halt “pill mill” activities and rogue online pharmacies that are coordinated with public health efforts to expand access to addiction treatment and recovery in order to ensure that those suffering from addictions do not resort to illicit drug use, such as heroin; and
- A public health approach that places a premium on treatment and includes promoting widespread adoption of drug courts.
The AMA has long held that the central principle of balance—between preventing controlled substance abuse, trafficking, and diversion and ensuring access to necessary pain medication—should guide policy-makers as they craft solutions to address these complex problems. From the outset of this crisis, the AMA has advocated for solutions that provide physicians with patient specific up-to-date information at the point-of-care in order to support appropriate prescribing.
While NASPER, a grant program to fund the creation of state prescription drug monitoring programs (PDMPs), passed in 2005, it was not until 2009 that funds were approved to support the program. While the majority of states now have a PDMP, most became operational only in the past couple years. Unfortunately, only a handful of PDMPs are real-time and few are readily available at the point of care as part of a prescriber's workflow. The NASPER Reauthorization and full appropriation offer an opportunity to make a strong commitment to combating prescription drug abuse and diversion.
The AMA developed and maintains free continuing medical education (CME) to promote appropriate prescribing for pain management and to combat drug diversion. The AMA strongly supports positive incentives to promote physician education as well as strategies that integrate and embed education into a physician's practice.
The AMA developed a free 12-hour Pain Management CME Program online in 2003, revised in 2007 and again in 2010. To date, approximately 155,000 CME certificates have been issued for the online version of this program, and 65,000 for the print version, with an additional 26,000 certificates issued to non-physicians, primarily physician assistants. This course is undergoing revision and will be offered again for credit in Spring 2013.
Through September 2014, the AMA is scheduled to develop and release 12 webinars on topics related to responsible opioid prescribing as part of the collaborative for the Prescriber Clinical Support System for Opioid Therapies led by the American Academy of Addiction Psychiatry and joined by the American Dental Association, American Medical Association, American Osteopathic Academy of Addiction Medicine, American Psychiatric Association, American Society for Pain Management Nursing, and the International Nurses Society on Addictions. Two such webinars are available.
Other education activities include:
The AMA produced an educational video vignette on prescription drug abuse which provides an overview on prescription drug abuse and offers tips for physicians on how to educate and counsel patients. This activity is part of AMA's Educating Physicians on Controversies and Challenges in Health (EPoCH) program.
The AMA supported the launch of NIDAMED which is devoted to educating physicians on issues surrounding substance abuse. As part of NIDAMED, AMA partnered with Prescriber Clinical Support System for Opioid Therapies NIDA Centers of Excellence via AMA's ISTEP program. These Centers of Excellence for Physician Information are charged with the task of developing innovative drug abuse and addiction curriculum resources with the goal of helping to fill the gaps in current medical students/resident physician curricula.
In conjunction with the Obama Administration's National Plan to Combat Prescription Drug Abuse and Diversion, the AMA hosted extremely well-attended education sessions at the AMA's 2011 Interim Meeting, and at its 2012 State Legislative Strategy Conference. Materials forthcoming.
H.R. 866, "National All Schedules Prescription Electronic Reporting Reauthorization Act of 2011" (NASPER 2011) would establish and modernize existing state-based prescription drug monitoring programs, and provide physicians with a basic tool to make treatment determinations based on patient-specific needs. The AMA has offered strong support not only for the reauthorization of NASPER, but we continue to urge Congress to provide full appropriations.
H.R. 2939, the “Pharmaceutical Stewardship Act of 2011,” would help combat diversion of prescription drugs as well as to safeguard drinking water from pharmaceutical contaminants. If made law, H.R. 2939 would establish an infrastructure to ensure that patients and physicians have a safe means of disposing of unused prescription drugs on a regular basis and at a time and place convenient to them, which would replace the current take-back programs that only occur periodically each year.
In addition, the AMA has offered support for legislation that would support appropriate efforts to ensure access to appropriate pain management, support treatment for substance abuse and addiction, and combat prescription drug abuse and diversion.
Harm Reduction Coalition letter to HHS supporting overdose prevention language in "FY 2013 Senate Labor Health and Human Services-Education (LHHS) Appropriations" report and the "Food and Drug Administration (FDA) Safety and Innovation Act," October 1012
The AMA has expressed concerns with rescheduling combination medication that will worsen access to needed pain treatment in long-term care.
The AMA has communicated its support for most elements of the Obama Administration's Plan to Combat Prescription Drug Abuse and Diversion.
In order to strengthen and improve state PDMPs, we have urged the Obama Administration to direct the Veterans Administration to share information with state PDMPs. We have also recommended that the Centers for Medicare & Medicaid Services direct Medicare Prescription Drug plan sponsors to also share information with state PDMPs and urged the Substance Abuse and Mental Health Services Administration to require reporting of methadone treatment to PDMPs.
Leadership from the AMA's Board of Trustees met with other key stakeholders as part of a Roundtable hosted by the Administration to identify technical barriers and strategies to ensure PDMPs are up-to-date and available at the point-of-care, and are part of a physician's work-flow. Challenges remain to making this a reality, but the NASPER Reauthorization and appropriations will provide needed resources to facilitate upgrade and modernization of existing PDMPs.
The AMA has also actively participated in providing comments related to the Food and Drug Administration's proposed elements to assure safe use of certain categories of opioids.
The AMA has also asked the DEA in the past, and the Administration recently, to waive or provide discounts on DEA registration fees for prescribers who take certified CME related to pain management prescribing and combating abuse and diversion, or who have qualifying specialized training.
The AMA has also supported agency efforts to increase access to detoxification treatment programs.
The AMA is working at the state level with state medical associations, national medical specialty societies and other physician and patient advocates to address the prescription drug abuse and diversion crisis. The following links provide information on AMA state level efforts and efforts by other stakeholder groups as well. To request additional information, please contact the AMA Advocacy Resource Center’s Daniel Blaney-Koen at Daniel.Blaney-Koen@ama-assn.org.
The AMA supports the Federation of State Medical Boards “Model Policy for the Use of Controlled Substances for the Treatment of Pain”
AMA has supported implementation of the National Association of Boards of Pharmacy software program "InterConnect" that provides HIPAA compliant interoperability for state PDMPs.
The AMA has also offered information on resources available to practitioners as well as areas where additional study would be beneficial to improving strategies to combat prescription drug abuse and diversion.
Physicians can use the AMA's medication disposal guide to remind patients to dispose of expired, unwanted and unused medicines properly. A training module from the AMA provides tips on educating and counseling patients about the dangers of prescription drug diversion.
On Aug 12, 2012, Steven J. Stack, MD, chair of the AMA Board of Trustees, wrote "Prescription abuse laws can create a no-win situation for doctors," an opinion piece that appeared in American Medical News.
In a April 5, 2012 opinion piece for The Hill's "Congress Blog," Peter Carmel, MD, president of the American Medical Association, writes that a nationwide electronic prescription drug tracking initiative could help curb drug misuse.