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.