Federal government and physicians: Working together to end opioid epidemic
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.”