A call to action: Physicians must turn the tide of the opioid epidemic

Steven J. Stack, MD
Immediate Past President
American Medical Association
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We have a defining moment before us—the kind of moment that we will look back on in years to come as one in which we as a profession rose to the challenge to save our patients, our families and our communities during a time of crisis.

Our nation is needlessly losing thousands of people to a preventable epidemic, and we must take action for our patients.

A time for action

Over the past 15 years, the nation’s opioid epidemic has claimed more than 250,000 lives, according to data from the Centers for Disease Control and Prevention (CDC). In the last year alone, we lost nearly 30,000 friends, neighbors, children and spouses.

Those numbers are alarming—and they require swift intervention.

In fact, there’s something of a parallel with what we’re seeing now and the early years of the HIV/AIDS epidemic. Nearly 320,000 people died in the first 15 years of that epidemic.

Thankfully, the narrative doesn’t end there. The nation’s policymakers, public health leaders and physicians came together to implement solutions that changed the course of history for people with an HIV/AIDS diagnosis and their loved ones.

It’s time to mount a similar response for the opioid epidemic. The loss of lives we are seeing around us and in the news every day is unacceptable—and we don’t have to accept it. Each and every one of us must band together to take specific actions that will turn the tide.

What we need to do

One of the great hallmarks of our profession is to run toward an emergency, to stand with our patients in the midst of their most pressing needs and to show the nation a clear path forward.

One way that our profession has done that for the opioid epidemic so far has been to convene a task force with more than 20 state and specialty medical associations, the American Osteopathic Association and the American Dental Association to identify best practices and implement them across the country.

For us as individuals, there are five specific steps we all must take:

  • We should register for and use our state’s prescription drug monitoring program (PDMP) if we treat patients for pain, mental illness or any other condition for which a controlled substance could be prescribed. Not every PDMP is perfect, but they provide important information that can help us when considering whether to prescribe a controlled substance for a particular patient.
  • We may need to enhance our education and training about safe prescribing. There are significant barriers to providing non-opioid and non-pharmacologic treatment alternatives, but we should ask ourselves two simple questions: When was the last time we looked at the research on opioid alternatives? And when was the last time we took education to ensure we are prescribing safely and appropriately?  The AMA has gathered more than 100 state and specialty-specific education resources in a one-stop shop for the best and most up-to-date education that organized medicine has to offer. Be sure to take advantage of these materials.
  • We should co-prescribe naloxone to patients at risk of overdose. The overdose reversal drug naloxone has saved more than 26,000 lives in the community in recent years, according to the CDC. The AMA Task Force to Reduce Prescription Opioid Abuse offers concrete recommendations for when you should consider co-prescribing naloxone to your patients.
  • We should get training to provide medication-assisted treatment (MAT) for substance use disorders. More of us need to be trained to recognize patients with substance use disorder, and more physicians need to become certified to increase access to treatment. Several medical organizations offer waiver-qualifying MAT training in multiple formats.
  • We need to speak out against stigma and stand up for what we know is right. Patients in pain deserve care and compassion, not judgment. Treating pain is among the most difficult—and most common—reasons patients come to us. As physicians, we are often under pressure to “satisfy a patient’s pain.” Sometimes this requires prescribing an opioid. But caring also means sometimes saying no and recommending an alternative course of treatment—no matter how difficult that may be.

Our nation’s opioid epidemic won’t end unless we become leaders by supporting the necessary policies and making the necessary practice changes. I urge you to join me in taking these steps today. Now is the time to act—this is our moment to turn the tide.

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Comments

Regarding Point # 5 above....slippery slope. It is clear from our country's current drug epidemic that we as a profession are guilty of over prescribing pain medication, specifically addictive narcotic pain medication. It is easier to write a refill than it is to confront a patient about over use of pain meds. We need to err on the side of NOT prescribing these medications as opposed to writing a refill. Have these patients get help early on and resist the temptation to get them out of your office with a refill.
I hate to be a cynic but this sounds like a continuation of "the war on drugs," which continues to be a losing policy. There is not enough money in the budget to pay for substance abuse mental health, and a doctor-responsible control policy by the government will just be more mandates and blame against health care providers. <br/> <br/> You are trying to change human behavior, and i doubt these are the correct tools for success...not sure if there is a good solution until you stop the >25% of our population from wanting to get high on illegal (and legal) drugs.
Physicians need to be viewed as partners and not adversaries in this effort. Too often prescribers are stigmatized, reprimanded, and targeted at administrative levels and by law enforcement. We've been deprived of respect and critical due process. Caring professional <br/> deserve educational efforts to bring opioid prescribing practices up to the standard of care.
I am an RN who works for a psychiatrist and we have been treating patients with Vivitrol with excellent success but we need to offer Suboxone to many because of the high cost of Vivitrol, but Suboxone can be sold on the street, shared and is addictive. I know there is a clinical trial presently with an injectable form of the drug, but it will be awhile before it will be available. If you could put some pressure on Alkermes to lower their price it would be a God's send. My physician has already reached out to the U.S Attorney General here in Atlanta and we hope to be on the Task Force. I have a 52y/o son who has been addicted for 35years and Vivitrol has saved his life. He has re-joined the family, has a job, is saving money, going to meetings , and a "joy" to be with.
In the 1980s I referred over 100 physicians to the Ohio Medical Board for prescribing medicines 'detrimental to the patient' - a phrase in the ORC defining medical practices that are subjeft to disciplinaqry action. That section also required any licensed physician to report to the board any such activities.<br/> I was then called to attend a meeting of the Ohio State medical Association for my actionsw- and when i cited that ection of alw - the president elect of the OSMA said: "Oh, yes, the snitch law" - we don't condone that.<br/> The medical baord took aciton on only one case, and that in private hearing that was never published - and in the early 1990s came out with 'rules' for chronic pain treatment, including about 15 items physicians practicing 'chronic pain' had to document. Within 2 months the 'abusers' of these patients suddenly had a check list sheet itemizing each item of the rule in sequence.<br/> A year later I was asked tospeak to the Ohio College of Occupational medicine on changes in the Ohio workers comp laws - they were concerned that their practicies might be adversely impacted by the managed case concepts of that law.<br/> At the end of my presentation I asked the attendees whether they had heard of the phrases "workers comp mills" or "medicare/medicaid mills".<br/> Everyone raised their hand.<br/> I then asked " do you like that phrawe being applied to the practice of medicine?"<br/> No one raised theeir hand.<br/> I then asked "are you aware of such a practice in your community?"<br/> Again everyone raised their hand.<br/> I then asked " have you every reported such practices to the Medical Board?"<br/> I was the only one who raised their hand.<br/> I then thold them "gentlemen, don't be surprised if third-party payors put all sorts of restrictions on who you can see, how often and how much of your bill for services they pay - because if you don't do something about the corrupt members of yoour 'profession' those footing the bill will have no choice but to take action against every member of the profession.<br/> Now all of a sudden we have an 'epidemic'? Why should we be surprised????<br/> It's time the AMA uphold it's tenets and insist on 'no harm'<br/> One more question: When was the last time the AMA revoked membership in the AMA of a phyisican who had blatently destroyed patient's lives before final action by any medical board?<br/> "Physician, heal thyself" - applies to the AMA as well.
My apologies for the typos - I hope those don't distract from the content of what I've written
Too little too late. I was involved in an effort to curb opiate abuse in North Carolina. We targeted the physicians to get them to change their prescribing practices, check databases, prescribe narcan kits and refer to pain clinics. This was fairly successful. BUT we were naïve and thought the patients would seek treatment. Guess what? Very few wanted treatment and they have turned to heroin which now is much cheaper than prescription opiate on the street. I believe that JCAHO is somewhat responsible for this epidemic. In reading this alert you will notice that the epidemic started 15 years ago. That is when they started to require pain as the 5th vital sign. They continue to propagate this with their regulation.<a href="http://www.jointcommission.org/pain_management/" rel='nofollow'>http://www.jointcommission.org/pain_management/</a><br/> <br/> I don't know, and no one else knows, the solution to this problem. I support the narcan Rx but I think it needs to go further. Suboxone should be over the counter.<br/> <br/> This is a terrible problem that is ruining lives.
This proposal has the ring of past failed ones which place the onus of responsibility on the clinician. Many states programs are merely adding a layer of bureaucracy to physicians prescribing practices. Some, like Nevada, require the doctor to access a state run data base on each patient to ascertain their past prescriptions, adding clerical burden to the overworked and unappreciated caregiver.<br/> The responsible party is the abuser. Our cultures insatiable desire for "the quick fix", and "the easy way out", as well as the medias glorification of of drugs and violence must share responsibility for this epidemic of drug abuse.
I can't help recalling that ten years ago physicians were criticized for not controlling patient's pain well. We had to attend educational sessions at our institution and the pain scale was created and implemented nationwide. Now we are the instruments of addiction. Which is it?
Dr. Stack, Perhaps you have forgotten that in California a Doctor was being sued for NOT prescribing a strong enough pain medication and at the same time a Doctor was being sued for prescribing a strong enough pain medication but the patient became addicted to the medication. The very first thing we need as Physicians is TORT REFORM. Also we must NEVER even think of prescribing a drug like marijuana that simply makes the patient NOT CARE if he has pain. THIS IS malpractice and if the patient really has a problem other than addiction and we prescribe a medication that makes the patient not care we should be sued. We must never sign up for ANY government medication followed program. The government should do that on their own with the pharmacies. Never put yourself in a situation where the government has control over what you do. We do not have to learn about addictive medicines since we already KNOW those medicines. If you have a patient with pain then reverse the cause and if you need pain medication for a time (usually 2 weeks) as you do that then tell the patient: this is addictive/you can only have it for 2 weeks. For the past 100 years liquid tetrahydrocannabinol has always been available for end stage cancer patients. Modern medicine is devoted to 'symptomatic treatment' rather than 'curative treatment'. Why? Because the former is easier.

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Feb 24, 2017
More than 20 million Americans have gained coverage since 2010. Health reform proposals should not result in these patients losing coverage.