Barriers to implementing electronic prescriptions of controlled substances remain a significant and perplexing burden for physicians. To further the AMA’s work in eliminating taxing restrictions, the AMA House of Delegates modified current policy to “continue to advocate before relevant federal and state agencies and legislative bodies for elimination of cumbersome, confusing and burdensome requirements relating to electronic transmission of physicians’ controlled substance prescriptions to pharmacies.”
This is commonly known as electronic prescribing for controlled substances, which includes Schedules II, II, IV and V drugs. The current guidelines for these schedules do not reduce the amount of administrative paperwork for physicians. Instead, the guidelines add to their current workload, which “defeats the purpose of electronic handling of prescriptions.”
The HOD also modified policy to continue to “work with the Centers for Medicare and Medicaid Services (CMS) and states to remove or reduce barriers” associated with “both controlled substances and non-scheduled prescription drugs.” That would include the “removal of the Medicaid requirement in all states” that physicians write these prescriptions by hand on paper forms.
The AMA will also “work with the largest and nearly exclusive national electronic pharmacy network, all related pharmacy regulators and with federal and private entities” to ensure “universal acceptance by pharmacies of electronically transmitted prescriptions.” Additionally, the AMA will advocate appropriate financial and other incentives to encourage physician adoption of e-prescriptions.
The AMA also will work with CMS and the federal government to ensure acceptance of e-prescriptions in all pharmacies. The AMA encourages the U.S. Drug Enforcement Administration to “support two-factor authentication that is easier to implement than current” security requirements. And because concerns exist about privacy, confidentiality and authenticity, delegates asked the AMA to modify existing policy to state “hard copy” facsimile transmissions are not supported as “the original written prescription for Schedule II controlled substances, except as currently allowed” in the Code of Federal Regulations.
Treating opioid-use disorder in prisons
Drug overdoses are now the leading cause of accidental death in the U.S. with opioids responsible for 61 percent, according to data cited in a resolution whose recommendations the HOD adopted with amendments. About one-third of heroin users pass through correctional facilities annually, with up to 60 percent of those incarcerated exhibiting a substance-use disorder, the resolution said.
However, prisons rarely treat withdrawal with opioid agonist therapy—the most effective treatment for this condition. To address this, the AMA adopted new policy advocating for “legislation, standards, policies and funding that encourage correctional facilities to increase access to evidence-based treatment of opioid use disorder.” This will include “initiation and continuation of opioid replacement therapy in conjunction with counseling” in U.S. correctional facilities. It will also apply to all incarcerated individuals, which includes pregnant women.
The AMA also adopted policy encouraging correctional facilities within the U.S. to “work in ongoing collaboration with addiction treatment physician-led teams, case managers, social workers and pharmacies in the communities where patients, including pregnant women, are released.” This stands to help maintain treatment plans for opioid-use disorder after incarceration, which should include education and counseling, as well as medication for addiction treatment and prevention of overdose deaths. The new policy also aims to ensure medical coverage and accessibility to medication assisted therapy after release from the correctional facility.
“Patients with opioid use disorder should not have their treatment interrupted once they enter prison. Access to evidence-based care is crucial to treatment, no matter what the setting,” said Patrice A. Harris, MD, chair of the AMA Opioid Task Force and immediate past chair of the Board of Trustees.
The HOD also adopted new policy that speaks to the benefits of breastfeeding in mothers with opioid use disorder, on medication-assisted treatment, or mothers who may require opioids for serious pain. Studies indicate that the use of methadone and buprenorphine have been found to be effective and safe maintenance therapies in pregnant and breastfeeding opioid-dependent women.
The new policy calls for the AMA to promote educating breastfeeding mothers on “the benefits and risks of using opioids or during medication-assisted therapy for opioid use disorder, based on the most recent guidelines.” Delegates also adopted the AMA’s policy on issues in care and prevention of perinatal addiction to include breastfeeding patients.
Delegates also moved to address the increasing risk of overdoses occurring in public areas. The AMA will urge the Food and Drug Administration to study the feasibility and usefulness of public overdose rescue stations—wall-mounted units, similar to automated external defibrillators that include naloxone and instructions for proper use.
More than 115,000 physicians have accessed, attended or completed continuing medical education and other courses offered by the AMA and state and specialty societies on opioid prescribing, pain management, addiction and other areas since 2015.
The AMA has online CME in this area, such as “A Primer on the Opioid Morbidity and Mortality Crisis: What Every Prescriber Should Know.” Training by state and specialty can be found at the AMA Opioid Task Force’s microsite.
Read more news coverage from the 2017 AMA Interim Meeting.