Advocacy Update

June 19, 2020: State Advocacy Update


The AMA is urging the Centers for Disease Control and Prevention (CDC) to make significant revisions to its 2016 Guideline for Prescribing Opioids for Chronic Pain (CDC Guideline) to protect patients with pain from the ongoing unintended consequences and misapplication of the CDC Guideline.

Haven't subscribed?

Stay current on the latest on the issues impacting physicians, patients and the health care environment with the AMA’s Advocacy Update newsletter.

"To make meaningful progress towards ending this epidemic, a broad-based public health approach is required," wrote AMA Executive Vice President James L. Madara, MD. "We are now facing an unprecedented, multi-factorial and much more dangerous overdose and drug epidemic driven by heroin and illicitly manufactured fentanyl, fentanyl analogs and stimulants. We can no longer afford to view increasing drug-related mortality through a prescription opioid-myopic lens."

Among its recommendations, the AMA called for the CDC to remove arbitrary limits or other restrictions on opioid prescribing given that there is no evidence they have improved outcomes for patients with pain, and in fact they have increased stigma for patients with pain and have inappropriately denied access to legitimate pain care for patients. "Hard thresholds should never be used. Where such thresholds have been implemented based on the previous CDC Guideline, they should be eliminated," Dr. Madara wrote, and also highlighted that CDC itself cautioned against misapplying the guideline to justify specific dose or quantity restrictions.

The AMA also urged CDC to add to its recommendations that "public and private payer policies must be fundamentally altered and aligned to support payment for non-pharmacologic treatments and multimodal, multidisciplinary pain care."

Read the full AMA letter and each recommendation to revise the CDC Guideline.

In an op-ed Patrice A. Harris, MD, MA, AMA Immediate Past President, writes about what states can do to help ensure the nation's opioid epidemic does not become worse during COVID-19. An excerpt follows:

"While we continue to take steps to address COVID-19 to help keep the public safe, the AMA has seen reports from more than 30 states PDF) concerning increases in opioid-related mortality, mental health crises, suicide and addiction-related relapse. Reports are from every region in the nation. This includes a 20 percent increase in calls to the Jacksonville, Fla., fire department concerning overdoses; an "unusual spike" in overdoses in DuPage County, Ill.; increased emergency department visits in coastal North Carolina and spikes in fentanyl-related overdoses in Seattle. Georgia, too, has not been spared, causing increased concern for many.

Social distancing, a dramatic increase in unemployment and widespread economic woes lend themselves to common substance misuse triggers: isolation and anxiety. The medical community often refers to addiction as "a disease of isolation," and Americans are at high risk now, even those who did not misuse opioids previously. Those who are homeless or incarcerated may be particularly vulnerable. At the end of April, 28 percent of Americans reported worsening mental health, and 34 percent reported worsening emotional well-being.

As these stories continue, the AMA is working with federal agencies to help protect our communities. In particular, the U.S. Substance Abuse and Mental Health Services Administration and U.S. Drug Enforcement Administration have increased flexibility for providing buprenorphine and methadone to patients with opioid use disorder, and the DEA has also increased flexibility to help patients with pain obtain necessary medications.

Additional steps must be taken to help ensure the nation's opioid epidemic does not become worse."

Read the full story.

The AMA this week urged OptumRx and United Healthcare (UHC) to delay a mandate for all physicians to use electronic prescribing for controlled substances (EPCS) for patients using home delivery beginning July 1. OptumRx, which previously delayed the EPCS mandate at the outset of the COVID-19 pandemic, said that it is moving forward due to its perception that primary care and other physician practices are returning to full capacity and ready to implement the EPCS requirement.

The AMA emphasized that OptumRx will begin to enforce its EPCS mandate on patients and physicians while the national COVID-19 Public Health Emergency remains in effect, likely causing disruptions in care for patients if their physicians are not currently EPCS compliant. The AMA pointed out that the OptumRx EPCS mandate is in contrast to efforts by the U.S. Drug Enforcement Administration and U.S. Substance Abuse and Mental Health Services Administration to increase flexibility for patients to maintain access to medications through telemedicine.

While OptumRx said that physicians can seek a waiver from the EPCS home delivery mandate, the AMA highlighted that many physician practices remain under significant stress and that it is the wrong time to add additional financial and administrative burdens for EPCS compliance.

Learn more information about the OptumRx EPCS mandate.