Dr. Harris noted that physicians are obliged to take a leadership role by “continuing to make judicious prescribing decisions, and by considering the full range of effective therapies for pain, including non-opioid and non-pharmacologic options, co-prescribing naloxone, helping patients access medication-assisted treatment (MAT) for opioid-use disorder, and removing stigma.”
A critical piece of the puzzle is meaningful insurance coverage for effective treatments, she said.
“Insurers must be willing to cover pain treatments beyond opioid analgesics, as well as long-term comprehensive treatment for opioid-use disorder to promote recovery,” Dr. Harris said.
2 more emergency steps to take
The AMA has advised officials in Washington on how to best address the opioid epidemic. In the September letter, AMA Executive Vice President and CEO James L. Madara, MD, asked the president for his assistance in removing barriers to opioid-use disorder treatment.
“America’s patients need your leadership to encourage health insurance companies and pharmacy benefit managers to end the type of prior authorization, step therapy, and fail-first protocols that only serve as barriers to MAT and multimodal pain care,” Dr. Madara wrote. “When our patients have care delayed or denied due to insurance company policies, it could mean further harm or even death.”
Dr. Madara urged federal action on the IMD exclusion and two other key areas.
Suspend federal regulatory and other barriers to providing buprenorphine. The requirement that physicians and others seeking to prescribe buprenorphine to treat opioid-use disorder obtain a special federal waiver should be done away with. “Removing the federal waiver requirement will give many more patients new access to treatment from physicians and other qualified health care professionals,” Dr. Madara wrote, noting that MAT is safe, effective and well-established.
Direct the attorney general to enforce existing substance-use disorder parity laws. The federal Mental Health Parity and Addiction Equity Act should be enforced at the state and federal levels. Leadership is needed “to encourage health insurance companies and pharmacy benefit managers to end the type of prior authorization, step therapy, and fail-first protocols that only serve as barriers to MAT and multimodal pain care,” Dr. Madara wrote.
“Some payers already have taken positive steps to remove some barriers, but this epidemic requires all payers to work with us to ensure access to care,” he added.
Coordinated effort needed
The scale of the opioid epidemic demands a unified, evidence-based, compassionate response. One of the purposes of convening the AMA Opioid Task Force in 2014 was to coordinate various efforts that were going on around the nation.
The task force first issued recommendations in 2015. The recommendations of the task force are to:
- Support physicians’ use of prescription drug-monitoring programs (PDMPs).
- Enhance education on effective, evidence-based prescribing and treatment.
- Support access to comprehensive, affordable, compassionate treatment.
- Put an end to stigma.
- Expand access to naloxone in the community and through co-prescribing.
- Encourage safe storage and safe disposal of prescription medication.
The number of opioid prescriptions dropped more than 43 million between 2012 and 2016, a 17.9 percent decrease, according to research cited in an AMA Opioid Task Force report. Use of PDMPs by physicians and other health professionals has skyrocketed, with the number of clinicians registered rising by 180 percent to more than 1.3 million in 2016. Nearly 120,000 physicians completed courses administered by state and specialty societies on opioid prescribing, pain management, addiction and related areas in 2015–2016.
The AMA offers online CME to expand your understanding of the opioid epidemic. Explore educational content such as "A Primer on the Opioid Morbidity and Mortality Crisis: What Every Prescriber Should Know." This educational module was recently honored by the prestigious Brandon Hall Group’s Excellence Awards Program in the “citizenship” category, which is for organizations that “recognize the opportunity, and social responsibility, to go beyond training ... and are on the forefront of social change and merit recognition for positively impacting our world.”