Federal government and physicians: Working together to end opioid epidemic

AMA Wire
Michael Botticelli
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Michael Botticelli, director of National Drug Control Policy at the White House, Wednesday underscored the essential role of physicians as clinicians and advocates in the effort to combat the opioid epidemic. “We at the federal level can’t do it alone,” Botticelli said. “It’s a crisis that requires an all-hands-on-deck approach, and we need partners like the AMA to help steer our ship safely.”


“We all know that it’s critical that health care leaders and stakeholders are part of our efforts,” Botticelli said at the conclusion of the 2016 National Advocacy Conference in Washington, D.C. “The [AMA] task force goals of increasing the use of prescription drug monitoring programs (PDMP), enhancing physician education, reducing stigma, and expanding access to lifesaving treatment and [the] opioid reversal drug naloxone are right on the money and clearly aligned with the administration’s priorities.”


Tragically, every day in America, 78 people die from overdose due to prescription opioids or heroin. This national epidemic presents many challenges, which is why the government and the physician community need to work collaboratively to ensure that policies are designed that help the situation and don’t unintentionally hurt the effort.


“We need to work together to support policies and changes in practice that will have a meaningful impact,” Patrice A. Harris, MD, chair-elect of the AMA Board of Trustees and chair of the AMA Task Force to Reduce Opioid Abuse, said when she introduced Botticelli at the conference. “Physicians must not only take responsibility—we welcome that responsibility, and we welcome your continued partnership in this effort.”


What physicians and the federal government can do together

According to a recent AMA survey, 90 percent of physicians said that PDMPs help them become more informed about their patient's medication history, including whether that patient is receiving multiple prescriptions from multiple health care professionals. 


“Our prescribing decisions must be judicious, deliberative and rooted in the art and science of medicine,” Dr. Harris said, echoing words she shared a few days before at the National Governors Association (NGA) Winter Meeting, where she was joined by Botticelli, Massachusetts Gov. Charlie Baker, New Hampshire Gov. Margaret Hassan and other prominent voices on the opioid epidemic. The AMA also issued a joint statement with the NGA, calling on physicians, governors, state legislatures and the private sector to come together to solve the crisis.


“Patients with pain and patients with substance use disorders deserve care and compassion, not judgement,” Dr. Harris said. ”They are our patients. They are not fakers or junkies or addicts; they are people who need our help. Stigma dehumanizes and demeans and does nothing to treat and cure.”


“Your advocacy and action is needed today,” Botticelli said to physicians. “As Dr. Harris talked about, we are in the midst of one of the most urgent public health crises, and it’s our defining moment to do everything we can to make positive differences in people’s lives.” 


These remarks came a week after AMA President Steven J. Stack, MD, shared a call to action with physicians, urging them to “turn the tide” of the opioid epidemic through five specific actions recommended by the AMA task force.


Some physicians have concerns that the patient satisfaction questions related to pain and pain medication in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey are leading to pressure to prescribe. 


“This came to our attention awhile ago in terms of the extent to which HCAHPS surveys might be contributing to overprescribing because of misaligned financial incentives,” Botticelli said. “The President announced in October that [the Department of Health and Human Services] was undertaking a review of that survey … to make modifications to those questions.”


Last month, President Obama also moved the ball forward in expanding treatment for opioid use disorders when he announced his fiscal year 2017 budget, calling for $1.1 billion in new funding to expand access to treatment for opioid misuse to “help people seek treatment, complete treatment and sustain long-term recovery,” Botticelli said. “But this budget is more than just funding. It represents our country’s largest investment in treating and preventing substance use disorders in history.”


“There’s a real need to make sure prescribers get the training they need, know their patients’ overdose history and use the tools at their disposal,” he said.


“The real lynchpin of our efforts to stop the opioid epidemic [is] physician education,” Botticelli said. Equally as important is “ending stigma around getting people the treatment they need and the care they need to recover from substance use disorders,” he said. Reducing stigma is among the key goals of the opioid abuse task force. “And it’s exactly what we need to get people on the road to recovery,” Botticelli said. 


“There are literally millions of people across the country who need our help, and they need it now,” Botticelli said, emphasizing the importance of expanding access to earlier intervention and treatment. “We know that medication assisted treatment (MAT) when combined with counseling, is a proven path to recovery.”


“It’s great to have [the AMA’s] support for this and for ending the stigma surrounding this,” he said. Several organizations provide physician training and resources on MAT.


Naloxone has quickly become one of the greatest tools for overdose intervention, and it’s saving lives all across the country. “Communities in many states are already using it to reduce overdose deaths,” Botticelli said. “But for those that aren’t, we need to make sure that every first responder is equipped to deliver naloxone when they need it and that people can save their friends and loved ones who are at risk for overdose.”


“Standing order programs and collaborative practice agreements are great ways to help people obtain these medicines,” he said. “We need … to recognize when patients might be at risk for an overdose and prescribe naloxone to patients for use by their loved ones or caregivers. And I appreciate the focus of the AMA on co-prescribing naloxone for patients at risk.”


Botticelli thanked physician advocates and the AMA for their work to “reduce the opioid use and overdose epidemic, strengthen the medical system through education, and reduce the effects of substance use on society,” he said. “I look forward to continuing to work together to improve our nation’s health.”

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Heroin isn't even a problem. Ask any addiction specialist about the worst addictions in America and heroin isn't in the top 10. These people just love incarcerating and oppressing the people. If playing basketball was their only excuse, it'll become a death sentence to play basketball. Mass incarceration is ruining this country more than any heroin or crack will ever do.<br/> <br/> Awilda Harrison<br/> Resume Writer - <br/> professional resume writing service<br/> <a href="http://www.osamresume.com/" rel='nofollow'>http://www.osamresume.com/</a><br/> 2003 Gnatty Creek Road<br/> Manhattan, NY 10016
It is very interesting that about 20-25 years ago there was a big cry to our government agencies that Doctors where not treating pain appropriately and a big push requiring CME training to maintain our license on treating pain was required. Our training 30-40 years ago was narcotics where used for short term for painful situations i.e. surgery etc. And longer term for oncology patient.<br/> <br/> Now nursing staff are required to ask and document level of pain and document what response the treatment had. Which I think is leading to much more use of narcotics in chronic pain with the development of dependance.<br/> <br/> I would recommend Paul Brand's book "The Gift of Pain" to all prescribers of narcotics and their patients.
What bothers me in this debate is how people like myself with legitimate needs for pain relief get painted with the same brush as the actual addicts and suffer the consequences. Somehow it needs to be remembered that there is a real need for long term pain relief in some individuals, while at the same time restricting the addicts access to the same.
Meanwhile, the people who are in desperate need of these medications to survive are being denied treatment due to opiophobic physicians. Now, pain management clinics are springing up everywhere- why? Because giving a suffering patient a'surgical procedure' which involves a simple steroid shot are charging insurance companies $7,000-$10,000 thousand $ per shot. They are raking in millions of dollars every week for unnecessary procedures. In perspective, the AMA should account for how many people die each day to tobacco or alcohol use. The AMA needs to get its priorities in order. Patients needs rank above unnecessary review boards, insurance company profits the almighty dollar. Canadians can buy opiates over the counter, they don't face the same issue of opioid fatalities. This whole issue is being blow way out of proportion soley to be exploited as 'SENSATIONALISM' by the media in the U.S.- The TOPIC of this issue is a way of increasing ratings of news channels. The actual problem, is extremely small compared to other health issues facing the citizens of the U.S.
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