AMA Task Force to Reduce Opioid AbusePatrice A. Harris, MD, MA

Chair-electAmerican Medical Association

March 29, 2016

© 2015 American Medical Association. All rights reserved.

• AMA Task Force to Reduce Opioid Abuse– Increase registration and use of PDMPs– Ensure safe, evidence-based prescribing– Support comprehensive pain care; reduce the stigma of pain– Reduce the stigma of substance use disorder; increase access to treatment – Increase access to naloxone to save lives from overdose; support broad

Good Samaritan protections

• www.ama-assn.org/go/endopioidabuse

2

© 2015 American Medical Association. All rights reserved.

Drug Poisoning Deaths Involving Opioid Analgesics and Heroin: United States, 1999–2014

Sources: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 20140

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

20,000

© 2015 American Medical Association. All rights reserved. 4

© 2015 American Medical Association. All rights reserved. 5

Increase registration and use of PDMPs

• Quickly and accurately access your patient's prescription history • Support delegate(s) in your practice to access the PDMP• Interstate interoperability• Create alerts for your patients • Contain referral information for co-occurring mental health or substance

use disorders

© 2015 American Medical Association. All rights reserved. 6

Physicians say that PDMPs can help provide important information about a patient’s prescription history

4% 3%8% 10%

45% 43%

42% 44%

Agree completelyAgree somewhatDisagree somewhatDisagree competely

Perceptions of state PDMPs in helping physicians to …

Be fully informed about your patients’ prescription history

Identify when patientsreceive multiple prescriptions

Agree87%

Agree87%

© 2015 American Medical Association. All rights reserved. 7

Ensure safe, evidence-based prescribing

• American Academy of Family Physicians • American Academy of Hospice and Palliative Medicine• American Academy of Pain Medicine• American Academy of Physical Medicine and Rehabilitation• American College of Emergency Physicians• The American College of Physicians• American Congress of Obstetricians and Gynecologists• American Dental Association • American Society of Anesthesiologists• American Society of Addiction Medicine• American Osteopathic Association • American Society of Interventional Pain Physicians

© 2015 American Medical Association. All rights reserved. 8

Total Primary care Specialists

(2130) (1219) (911)

Safe opioid prescribing 69% 68%

Pain management with opioid alternatives 54% 56%

Treatment and prevention of substance use disorder 45% 35%

Prevention of diversion 30% 22%

PDMPs 17% 17%

Naloxone 16% 17%

Medication assisted treatment 14% 15%

Other 5% 5%

68%

55%

40%

26%

17%

17%

15%

5%

7 in 10 physicians took education on safe opioid prescribing, and more than half on pain management with alternatives.

Education taken by physicians

© 2015 American Medical Association. All rights reserved. 9

Support comprehensive pain care; reduce the stigma of pain

© 2015 American Medical Association. All rights reserved.

Reduce the stigma of substance use disorder; increase access to treatment

1. Stigma – misunderstanding of the disease2. Capacity – lack of trained and willing providers3. Access – treatment limits imposed by

policymakers & insurers

“Over the last decade, the vast majority ― about 8 in 10 ― of all individuals with an opioid

use problem were not receiving any treatment at a given point in time, and rates of treatment

did not improve over the decade despite a dramatic

increase in deaths related to prescription drugs.”

- Brendan Saloner, PhD

Saloner B and Karthikeyan S. Changes in Substance Abuse Treatment Use Among Individuals With Opioid Use Disorders in the United States, 2004-2013. JAMA. 2015; 314(14):1515-1517.

© 2015 American Medical Association. All rights reserved. 11

Increase access to naloxone; co-prescribe naloxone;support broad Good Samaritan protectionsQuestions for physicians to consider before co-prescribing or prescribing naloxone:• Is my patient on a high opioid dose?• Is my patient also on a concomitant benzodiazepine prescription?• Does my patient have a history of substance use disorder?• Does my patient have an underlying mental health condition that might make him or

her more susceptible to overdose?• Does my patient have a medical condition, such as a respiratory disease or other co-

morbidities, which might make him or her susceptible to opioid toxicity, respiratory distress or overdose?

• Might my patient be in a position to aid someone who is at risk of opioid overdose?

© 2015 American Medical Association. All rights reserved.

• AMA Task Force to Reduce Opioid Abuse– Increase registration and use of PDMPs– Ensure safe, evidence-based prescribing– Support comprehensive pain care; reduce the stigma of pain– Reduce the stigma of substance use disorder; increase access to treatment – Increase access to naloxone to save lives from overdose; support broad

Good Samaritan protections

• www.ama-assn.org/go/endopioidabuse

12