AMA in the trenches: Combating drug overdose while managing patients' pain

David O. Barbe, MD
American Medical Association
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One of the most important outcomes from the AMA Interim Meeting in November was a renewed focus on national drug control policies and the responsible prescribing and use of prescription pain medication. This is a hot issue—and a difficult one for all of us. 

As a recent study has shown, about 45 Americans die every day from unintentional overdoses involving prescription pain medication. We also know that approximately 70 percent of people who misuse opioid analgesics obtain them from friends or family members, not physicians. Yet for policymakers, it’s often simpler to tighten controls on prescribing—such as the U.S. Food and Drug Administration’s move to reclassify hydrocodone to a Schedule II drug—rather than focusing on a broader public-health-based approach. 

As physicians, we don’t always have the support we need from the medical or public health infrastructure. Community-based programs for addicts and at-risk youth are lacking, and mental health networks and pain specialists are nonexistent in many areas. In addition legislative efforts designed to reduce supply or create practice standards can make treating pain patients more difficult for physicians. 

But there is hope in some recent developments. In November, a national association of state lawmakers (NCOIL) adopted best practices to curb opioid abuse, misuse and diversion. This new public policy framework was shaped in part by AMA advocacy and testimony. 

The AMA’s new policies should drive further movement in the right direction. Among other things, our policies call for: 

• Changes to the focus of National Drug Control Policy, including more community-based prevention programs for at-risk youth and increasing accessibility of treatment programs for substance use disorders.

• AMA collaboration with other medical associations to develop and promote best practices for using opioids in pain management. 

• More robust data collection by the Centers for Disease Control and Prevention on unintentional opioid poisonings and deaths so our nation can develop appropriate solutions for prevention.

• Re-evaluation of the Joint Commission’s accreditation standards to improve pain management practices.

The AMA continues to work on multiple fronts to ensure physicians can both adequately treat patients’ pain and prevent abuse, overdose and death from prescription drugs.

A good example is our continuing medical education series on pain management, which provides information to help physicians strike a balance between managing patients’ chronic pain and preventing prescription painkiller abuse. Updated last year, the 12 online modules offer AMA PRA Category 1 credit™.  I encourage you and your colleagues to take advantage of these excellent resources.

Another example is the AMA’s legislative efforts to advance state bills that support the availability and administration of naloxone—a proven opioid antagonist—to help reduce deaths from opiate overdoses. Several states, including California, Colorado, New Jersey and Oklahoma, adopted such legislation in 2013.

As physicians, we need to be equipped to balance our ethical obligation to treat patients with pain alongside the need to identify signs of diversion.  However, we also need coordinated, constructive programs that support treatment and prevention. The new AMA policies, along with existing efforts, aim for both. 


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I can't help wondering if the extra availability of naloxone isn't going to just fuel increased use of drugs by addicts because they now can assume, rightly or wrongly, that someone will come along and save them.<br/> <br/> Still having said that, things are moving in a better direction than a year ago.
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