What physicians can do to stop the opioid overdose epidemic

Patrice A. Harris, MD, MA
Board Chair
American Medical Association
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With 44 people dying each day in the United States from an overdose of opioids, we physicians see people affected by this epidemic on a regular basis—whether it’s in our local newspapers or in our own offices.

From the inner city to the suburbs and rural regions, no community is untouched. But there are things we can do to amplify our current efforts.

That’s why the AMA has convened a task force with more than 20 state and specialty medical associations, the American Osteopathic Association and the American Dental Association to work collaboratively to address the opioid public health epidemic by identifying best practices and implementing them across the country. This epidemic is complex, and the remedy won’t be simple. It will require a sustained, comprehensive approach.

As a group, we have developed a strong roadmap that we hope will bring America’s physicians, other health care professionals and patients together as partners on the path to eliminating this public health epidemic.

Our initial focus is on steps we physicians can take now to help our patient populations:

  • Use state-based prescription drug monitoring programs (PDMP). We should register for and consult these databases to identify patients at risk for opioid misuse and help patients with use disorders get appropriate treatment.
  • Discuss with patients available treatment options. When caring for patients with pain, we need to understand the best possible course for managing that pain with the tools available to us.
  • Take advantage of educational opportunities. Engaging in robust education activities that meet the needs of our specialties, practices and patient populations is key to delivering appropriate care for each patient. Visit the AMA’s Opioid Abuse Prevention Web pages to access resources to enhance your education, and promote comprehensive, appropriate pain treatment while safeguarding against opioid overdose. Resources also support treating patients with substance use disorders and expanding access to naloxone.

The AMA also is calling on states to make sure their PDMPs are truly valuable tools. These databases need to protect patient privacy, contain relevant and reliable data, allow care teams to seamlessly integrate that data into their work flows, and enable data sharing across state lines.

In the coming months, we’ll share additional recommendations and educational resources from the task force that can help you in your daily practice of medicine.

America’s patients who live with acute and chronic pain deserve compassionate, high-quality and personalized care. We are committed to equipping the physician community to achieve that goal so patients can live longer, fuller and more productive lives.

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Comments

I have questions about the following statistic quoted by Dr. Harris, for which no citation is provided, that there are "44 people dying each day in the United States from an overdose of opioids". I assume that figure does not include hospice patients, or those with incurable illnesses who choose assisted suicide. What percentage of the overdoses involve street drugs such as heroin, which are never prescribed, and over which physicians have no control? I have read new practice guidelines which discourage opioid use for patients with chronic non-cancer pain, regardless of how low-risk the patient may be for overdose, or how long the patient has been stable on their opioid regimen. The statement "opioids are ineffective for chronic neuropathic pain" appeared in an official state medical board guideline, which is contradicted by the relevant Cochrane review. Opioids are the gold standard for treating most severe pain, and erecting excessive barriers between innocent pain patients and the opioid medication they may need is not humane or ethical.
Thanks for your efforts and focus on this important issue.<br/> <br/> I think that equal attention needs to be placed on the role of prescription opioids as a gateway to substance abuse and addiction. I think this is a population of patients with an unmet need from a healthcare perspective, but also from a community/society perspective where addiction is stigmatized and federal dollars for managing substance abuse from opioids is insufficient.
I am an 'innocent pain patient', whose chronic pain was being adequately controlled by opiates for seven years. I had to move to Michigan where they pride themselves on never prescribing opiates. I used to have a full life, but now I am bed ridden without the medicine. Your program has negatively affected my care, because physicians are afraid to prescribe pain medicine. You have created a culture that is biased against the physicians who help people who are in pain. Why don't you focus some effort on discerning between real pain patients and abusers, instead of ruining the lives of real pain patients.
I am a mother who lost my 22 year old daughter to heroin on March 30th. My daughter was in Michigan, she started her addiction in Florida. Florida started this year where you have to get any narcotics from a pain management doctor. Your regular doctor can only write you a script until you can see the pain management Dr.
Why is not pharmacy mentioned as specialty organization? many states now allow pharmacists to prescribe naloxone kits to family members. CT has just joined the group. The AMA should stop trying to block pharmacists from areas where they are so much more accessible than physicians.<br/> jp
The most efficient way to turn this physician controlled fatal epidemic around is for the AMA to mandate CME for controlled substances, mandate usage of the PDMP for controlled substances, and set significant license and/or DEA registration violations for failure to comply.<br/> In addition, remove the linkage to "pain" and focus on prescribing behaviors for any condition.<br/> Just as importantly, the AMA needs to publish data that shows (as it does in FL) that "taken as prescribed" is causing more morbidity and mortality than "misuse and/or abuse".<br/> Furthermore, the AMA must step up to the plate to assure that each city, county, and state has adequate regulated treatment beds to take care of an entire generation of iatrogenic addicts.
Suggest including Addiction Medicine on the task force.
Wyoming has a Palliative Care Program that works with a central registry of prescriptions written and by whom and when. I am a member of that program because I have chronic pain and inflammation for several reasons. A doctor recently said, well, I've gone as far as I can without prescribing pain medication so that's for the Palliative Care people. I adored that statement. The other thing that program<br/> does is get me on pain medication that doesn't just knock me out and leaves me some capacity to function. It is a lifesaver. So what I want to say to this doctor is, if you're coming to Wyoming to change our program, don't. We don't need your help and your entire perspective seems to be that opiates are not necessary. You're wrong. Sometimes people really do need them. You clearly cannot see that as a valid statement. I don't think you have much contact with the real world and real pain. This article disappoints a follower of the AMA and its forward thinking authors.
The PDMP system is systemically FLAWED.. Pharmacists have no way to validate the ID they are presented.. which they enter that information into the PDMP database.. forged Rxs and IDs are rampant.. The PDMP is not going to show those who have fake multiple ID's.. they are the serious diverters or addicts. The "holy grail" that could be used to validate a pt's ID is the state's BMV's database.. if healthcare professionals could scan in a driver license and get back name, dob, pic.. if the person in front of you does not match the information on the driver's license presented nor the info from the BMV's database.. why would any healthcare professional prescribe or dispense any medication to them.. if they are going to mis-represent who they are.. what makes anyone believe that anything else they tell you about their health issues has anything to do with reality ?
I am sorry for your loss. What is your opinion of the restrictions placed on prescription opioid pain medications in Florida? Do you believe these restrictions might have prevented your daughter from her fatal heroin overdose? Do you know that heroin overdose is usually caused by the extreme variation in potency of "street" drugs? Physicians are not permitted to treat heroin addiction with prescription opioids which have stable and predictable dosing, except for rare methadone clinics. Tragically, methadone is an exceptionally dangerous opioid and has an insidiously high risk for overdose - and is a terrible choice for an addict to replace heroin.

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Patrice Harris, MD
Dec 01, 2016
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