The best approach
A comprehensive public health approach is needed to address prescription opioid-related harm and the growing heroin epidemic.
Steps in finding a solution
Here are a number of actions physicians can take to help end the epidemic:
- Register for and use their state prescription drug monitoring program
- Enhance their education about safe and effective prescribing practices and other approaches to treating pain
- Increase access to comprehensive treatment for opioid use disorders, including medication-assisted treatment (MAT), for example, by becoming trained to provide it or by referring their patients for this treatment
- Ensure that patients in pain receive the care they need and avoid the stigma of pain
- Reduce the stigma of having a substance use disorder (SUD) through recognizing that they are treatable medical conditions
- Increase access to naloxone through co-prescribing and other overdose prevention measures, and expanding Good Samaritan laws
The AMA supports:
- Full funding for up-to-date, interoperable, at the point-of-care prescription drug monitoring programs that are integrated into a physician’s workflow
- Tools and resources that support identification and assessment of SUD treatment gaps and appropriate targeting of funding and resources to expand access to treatment
- Support for a national framework to support accessible community-level take-back locations to remove unneeded prescription drugs including controlled substances from the household
- Voluntary physician education programs on safe prescribing practices that are tailored to meet a physician’s practice/patient population needs
- Enforcement actions to halt “pill mill” activities and rogue online pharmacies
- Coordinated public health efforts to expand access to legitimate pain management providers as well as SUD treatment and recovery
- A public health approach that places a premium on overdose prevention, education and treatment
The AMA has long held that preventing and reducing prescription drug misuse, and diversion while ensuring access to necessary pain medication should guide policymakers as they craft solutions to address these complex problems. From the outset of this epidemic, 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 AMA strongly supports NASPER Reauthorization and its full funding, which offer an opportunity to make a strong commitment to combating prescription drug misuse and diversion, as well as developing best practices for using PDMPs.
The AMA Task Force to Reduce Opioid Abuse has compiled several state, federal, academic and medical specialty society educational resources to promote appropriate prescribing for pain management, reduce prescription opioid-related harm and combat drug diversion. The AMA encourages the development of a wide range of educational materials and urges physicians to seek out educational opportunities appropriate for their particular practice and patient population.
The AMA developed several webinars on topics related to the intersection of pain, substance use disorders and opioids, also as part of the PCSS-O collaborative. Webinars developed by the AMA are archived.
The AMA supported the launch of NIDAMED, which is devoted to educating physicians on issues surrounding substance misuse. 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 misuse and addiction curriculum resources with the goal of helping to fill the gaps in current medical students/resident physician curricula.
Federal legislative activities
Passage of H.R. 1725/S. 480, the National All Schedules Prescription Electronic Reporting Reauthorization Act of 2015 (NASPER 2015) and full appropriations is urgently needed to ensure that physicians across the country have a critical tool at the point-of-care to combat prescription drug misuse while ensuring patients with legitimate need of pain management continue to have access. Unfortunately, the appropriations to fully fund, modernize and optimize NASPER PDMPs have not kept pace with the rapid escalation in the opioid misuse epidemic. Fully funded PDMPs would provide more physicians with access to reliable, real-time information about prescriptions patients have obtained (and filled) from other prescribers, particularly controlled substances.
Federal agency and administration activities
AMA Oct. 21, 2015 statement about AMA Partnering with the Administration to Halt Nation’s Opioid Crisis
AMA Oct. 1, 2015 comments on CDC Draft Guidelines for the Use of Opioids in Chronic Pain
AMA May 20, 2015 comments to NIH on Draft National Pain Strategy
AMA April 28, 2014 comments to DEA regarding Rescheduling of Hydrocodone Combination Products from Schedule III to Schedule II
April 28, 2014 coalition letter to DEA Administrator urging delay in finalizing proposal to reschedule hydrocodone from Schedule III to Schedule II until long-term care exception or special procedure is developed
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 misuse 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. The AMA has also supported the Department of Defense’s proposed revisions to the TRICARE regulation to reduce administrative barriers to access to mental health benefit coverage and to improve access to substance use disorder (SUD) treatment. 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 Misuse 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 workflow. 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 misuse and diversion, or who have qualifying specialized training.
To access previous AMA advocacy efforts on federal legislation regarding opioids, please visit the Federal and State Correspondence Finder.
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 national opioid epidemic. The following links provide information on AMA state-level efforts and efforts by other stakeholder groups as well. To request additional information, please contact Daniel Blaney-Koen at [email protected]
Collaboration with other stakeholders
The American Medical Association has joined with organizations representing physicians, pharmacists, supply chains and other stakeholder groups to develop a consensus document highlighting the "red flag" warning signs of prescription drug misuse and diversion. By illuminating the challenges of prescribing and dispensing opioids, the groups aim to prevent the misuse and diversion of controlled substances while ensuring access to the medicines for patients with legitimate needs.
Alliance to prevent the misuse of medicines
The AMA is a founding partner of this organization, which brings together a coalition of stakeholders to address prescription drug misuse.
National Governors Association
The AMA recently provided a comprehensive set of recommendations to the National Governors Association (NGA) as part of the NGA's work in its Policy Academy Prescription Drug Abuse Project.
National Conference of Insurance Legislators
As part of the AMA's national advocacy to help combat prescription drug misuse and diversion, the AMA has provided extensive recommendations for best practices to the National Conference of Insurance Legislators (NCOIL). The AMA also sent a follow-up letter to NCOIL regarding proposed best practices, and provided a statement to NCOIL on proposed best practices to address opioid abuse, misuse and diversion.
Federation of State Medical Boards
For the first time since 2004, the Federation of State Medical Boards (FSMB) is significantly revising its Model Pain Policy, and the AMA recently provided detailed comments that balance physicians’ needs to manage pain while avoiding diversion and substance misuse. In achieving that balance, the AMA believes that the nation’s challenges in combating prescription drug misuse and diversion must be focused on public health solutions that promote physician education and public awareness.