CHICAGO — The American Medical Association (AMA) adopted new policies this week at its annual meeting to reverse the country's opioid epidemic. The new policies encourage physicians to co-prescribe naloxone to patients at risk of an overdose; promote timely and appropriate access to non-opioid and non-pharmacologic treatments for pain; and support efforts to delink payments to health care facilities with patient satisfaction scores relating to the evaluation and management of pain.
"The AMA and our nation's physicians have demonstrated our commitment to ending this epidemic," said Dr. Patrice A. Harris, chair-elect of the AMA and chair of the AMA Task Force to Reduce Opioid Abuse. "These new policies build on the work of our task force, which has made clear that physicians must take a leading role in reversing the tide of this epidemic."
At the annual meeting, Dr. Harris led a panel discussion on opioids that asked the question: With 78 opioid-related deaths a day, what can one physician do? Dr. Harris and the expert panel highlighted how to more effectively use prescription drug monitoring programs; the benefits of non-opioid and non-pharmacologic treatment, and the importance of co-prescribing naloxone to patients at high risk of overdose. Dr. Harris urged the physicians in attendance to apply the lessons in their practices.
The new naloxone policies will promote increased access to the overdose-reversing drug for friends and family members of patients at risk of overdose. The policy also encourages private and public payers to include all forms of naloxone on their preferred drug lists and formularies with nominal or no cost sharing. The policy supports liability protections for physicians and other authorized health care professionals to prescribe, dispense and administer naloxone. Delegates called for policies to enable law enforcement agencies to carry and administer naloxone, as many states have done.
The policy calls for "collaborative practice agreements" with pharmacists, as well as standing orders for pharmacies, where permitted by law. It also advocates for availability of naloxone to community-based organizations, law enforcement agencies, correctional settings and schools.
"These policies will save lives. That's the bottom line," Dr. Harris said. "Time and time again, we have seen naloxone save lives once it is in the hands of first responders. We just have to make sure that we are co-prescribing it when clinically indicated, and that it is affordable for the community and available at local pharmacies."
Delegates adopted a policy that calls on the AMA to oppose efforts that would arbitrarily restrict a patient's ability to receive effective, patient-specific, evidence-based pain care.
"Patients in pain need comprehensive care and compassion. When proposing treatments, we must ensure that policies are grounded in science." Dr. Harris said. "Also, insurers must cover non-opioid and non-pharmacologic therapies that have proved effective. Insurers must take a broader view to give patients and physicians more choices."
Delegates also recommended breaking the link between patient satisfaction surveys of pain treatment and payments to facilities. Supporters said eradication or total resolution of a patient's pain is often misguided and puts inappropriate pressure on clinical pain management practices that can encourage the overuse of opioids, especially since other approaches are not covered by insurance.
"Treating pain is a priority for physicians, and we know that there are many ways to do it. We must ensure that patients have access to comprehensive pain care as well as reduce the stigma of pain," Dr. Harris said. "Judging health care facilities on an overly subjective measure – that is, how well it is perceived that they treat pain -- is an overly simplistic approach to measuring clinical effectiveness."
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