The rate of fatal prescription drug overdoses involving opioids in the United States almost quadrupled over the past decade, according to the Centers for Disease Control and Prevention (CDC)—and physicians on the front lines of patient care see the human toll this epidemic takes every day.
Deaths from heroin also have increased substantially. According to the CDC, more than 8,000 people died from heroin-related causes in 2013—a 39 percent increase from 2012.
“Communities across the United States have seen a tragic rise in heroin-related deaths,” AMA Board of Trustees Secretary Patrice A. Harris, MD, told a congressional committee in April. “Some suggest this is due to restrictions on prescribing prescription opioids or the lower cost and easier accessibility of heroin. There may be other reasons as well, and we need the data to help guide our interventions, but it is clear that we need to act.”
“We need a comprehensive public health approach to combatting the nation’s prescription opioid abuse and growing heroin epidemic,” said Dr. Harris, who directs county health services in the Atlanta area, including health partnerships that deliver a wide range of public safety, behavioral health and primary care treatment and prevention services. “It is up to physicians to be leaders in preventing and reducing abuse, misuse, overdose and death from prescription drugs through ensuring appropriate prescribing practices as one part of a multi-pronged public health strategy.”
Dr. Harris emphasized six key actions physicians can take:
Follow appropriate prescribing practices
Enhanced education about pain management can help physicians and other prescribers identify the risks of prescription drug misuse and help prevent diversion and overdose. Physicians can take the lead in training and educating themselves and their colleagues to make informed prescribing decisions, consider all available treatment options and make appropriate referrals for patients with opioid use disorders. Ideally, education will begin in medical school. The AMA is developing new training materials on responsible opioid prescribing as part of a collaborative with the Prescriber Clinical Support System for Opioid Therapies. It’s also creating an educational module on opioid risk management for residents.
Ensure patients in pain aren’t stigmatized
Patients who require opioid therapy to manage their pain shouldn’t be stigmatized. This means avoiding using terms like “drug seeker” for these patients, Dr. Harris said. “Patients who need care are simply ‘patients,’ and we should seek to change the tone of the debate toward more attention on multidisciplinary, patient-centered approaches to pain management,” she said. This includes addressing the lack of access to non-pharmacologic approaches. Because objective tests for the presence of pain are still at a basic stage of development, the best clinical approach most often is to assume the patient is reporting a true experience.
Support increased coverage for and access to treatment
Opioid use disorder is a chronic disease that can be treated effectively, but it requires ongoing care. The health care community needs more resources to ensure access to evidence-based treatment, including broad-based treatment services as well as medication-assisted treatment, Dr. Harris said. Comprehensive insurance coverage for such treatment is necessary. “We are deeply concerned by the barriers faced by physicians in finding and placing patients in addiction treatment and recovery programs,” Dr. Harris said. “A profound need exists to address the workforce limitations and the lack of accessible and affordable treatment programs.”
Support overdose prevention measures
Many states are enacting laws that increase access to the opioid overdose-reversal drug naloxone, specifically to trained first responders and friends and family members who may be in positions to help save lives. “Good Samaritan” laws also protect and encourage friends, family members and bystanders who may witness an overdose and are in a position to help provide care and call for help.
Use and support prescription drug monitoring programs (PDMP)
Physicians must examine their prescribing practices and be sure they are appropriate. If available, physicians should consult PDMPs when clinically indicated. Every state except Missouri has passed legislation establishing PDMPs. However, some PDMPs need to be modernized and fully funded to make them truly useful.
Work with stakeholders in your state
State and specialty medical societies and the AMA are working together to ensure new policies directly address this national epidemic. Different regions of the country have different problems, which is why a one-size-fits-all approach does not work. “The interventions needed in more rural parts of Kentucky and Tennessee, for example, might differ from what is needed in the Chicago, Philadelphia or Denver suburbs,” Dr. Harris said. Nearly every state legislature is considering one or more laws dealing with opioid misuse. The AMA and state medical societies have worked together to advocate for solutions that will positively change physicians’ prescribing practices and ensure patients’ access to care.
Learn more about how physicians nationwide are combatting prescription drug abuse and diversion.
