Opioids

Physicians took multifaceted approach to opioid epidemic in 2017

An AMA Opioid Task Force report issued this spring showed that physicians are working to help end the nation’s opioid epidemic. This includes reducing opioid prescriptions, getting educated on pain-management issues, becoming certified to provide office-based medication-assisted treatment (MAT), and making more use of prescription drug-monitoring programs (PDMPs). Here are some of other news developments AMA Wire® has reported on this year.

Physicians and students being educated on safe opioid prescribing. The AMA Opioid Task Force report noted that 118,550 physicians completed courses offered by state and specialty societies on opioid prescribing, pain management, addiction and other related topics in 2015 and 2016. These efforts continued in 2017 with the Maryland State Medical Society (MedChi) facilitating free training programs on the how to use the Screening, Brief Intervention and Referral to Treatment strategy and how to make better use of the state’s PDMP. “One of our roles is education outreach,” MedChi CEO Gene Ransom said.

Modules on safe opioid prescribing for chronic pain and “what every prescriber should know” about opioid morbidity and mortality were made available on the AMA Educational Center website.

Amid an epidemic, these physicians are taking action. Physicians such as Dr. Wakeman and David Dickerson, MD, are taking immediate action to help patients. As director of the University of Chicago Medicine’s acute pain service and chair of its Pain Stewardship Program, Dr. Dickerson advocates for a holistic approach that includes customizing care for individual patients, reducing the supply of opioids vulnerable to diversion and increasing access to MAT.

New role and practice model for pediatric primary care. There are too few pediatric physicians specializing in addiction medicine and too few inpatient treatment beds, according to Sharon Levy, MD, director of the Adolescent Substance Abuse Program at Boston Children’s Hospital and the American Academy of Pediatrics representative on the AMA Opioid Task Force. The solution advocated by Dr. Levy includes integrating opioid use disorder treatment into pediatric primary care.

Payers and policymakers need to follow evidence. Strong evidence exists on how to treat opioid-use disorder. The challenge is getting payers and policymakers to understand it so that physicians and other health professionals are better able to follow it, according to Sarah E. Wakeman, MD, medical director of the Substance Use Disorders Initiative at Massachusetts General Hospital. “We spent many decades trying to punish people into getting well,” Dr. Wakeman said, and this approach has not worked.

President directs declaration of opioid public health emergency. In his October announcement, President Donald Trump encouraged states to seek a waiver from a 1970s Institute for Mental Disease exclusion rule restricting Medicaid funding for inpatient treatment to facilities with no more than 16 beds. A report from the president’s Commission on Combating Drug Addiction and the Opioid Crisis had recommended this move as “the single fastest way to increase treatment availability across the nation.”

The president’s announcement was welcomed by the AMA, and Patrice A. Harris, MD, chair of the AMA Opioid Task Force, stressed that 

“Ending the epidemic will require physicians, insurers, drug manufacturers, and the government to follow through with resources, evidence-based treatment plans and smart public policies at the national and state levels,” Dr. Harris said.

Requirements of the Mental Health Parity and Addiction Equity Act not being met. That was the conclusion of a study looking at seven major health plans in New York and Maryland. The study cited other research that found only 10 percent of the 20.8 million of people who met addiction criteria received any treatment, in part because barriers to insurance coverage remain hard to identify. Also, enforcement of the Parity Act is driven by consumer complaints, but families and patients often don’t know what their coverage is supposed include, or how or where to complain.

AMA urges attorneys general to follow Schneiderman’s lead. Last year, New York Attorney General Eric Schneiderman reached an agreement with Cigna to end prior authorization for MAT. He followed it up in January with an agreement with Anthem to do the same. The AMA followed up that news with a letter to the National Association of Attorneys General urging them to work with insurers in their states to take action against MAT prior authorization requirements.