Now comes the hard part: Turning national attention into action

Patrice A. Harris, MD, MA
Board Chair
American Medical Association
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A father of five in Charleston, W. Va., last month told President Obama at a public event that if it weren’t for the quick response of police and paramedics earlier this year, his daughter would have died from a drug overdose. She is now in recovery, and the president—and the rest of us in the East End Community Center that day—wished him and his daughter the best.

Recovering from addiction, however, is not like recovering from a broken bone. It is a chronic medical disease that demands our care and compassion—as physicians and as a nation. We know that more than 24,000 Americans die from a prescription opioid or heroin-related overdose every year. Last month in Charleston, the president, the AMA and dozens of national and local organizations from across the country pledged to take action.

The hard part is now before us. We need to turn national attention on the problem and the need for greater education and treatment into measurable reductions in opioid-related harm. And we need to do this while preserving access to safe and effective pain care. For physicians, this means that we must act in several clear ways:

Register for and use your state prescription drug monitoring program (PDMP)

Do this whether you prescribe opioids or not. An effective PDMP can help inform your prescribing decisions by letting you review the patient’s prescription history and identify signs of potential red flags for substance use disorder. Visit the AMA’s PDMP directory to access your state’s PDMP.

Bolster your education

When was the last time you took a course on safe opioid prescribing, diagnosis and treatment of substance use disorder, pain management, or other related topics specific to your specialty? The AMA Task Force to Reduce Opioid Abuse has collected the best resources from more than 70 medical societies and other organizations to help you enhance your education as you work to improve patient outcomes.

Become trained to provide medication assisted treatment

If there was one message that rang loudest in Charleston, it was the call to remove the stigma of suffering from  substance use disorders. This also includes increasing access to treatment—and that means more physicians need to be able to offer that treatment. If you are interested in being a part of this solution, the American Society of Addiction Medicine offers waiver qualifying buprenorphine training in multiple formats, which covers what you need to know. 

Co-prescribe naloxone

This drug, which helped save the life of the daughter in Charleston, has saved tens of thousands of lives in communities across the country. Now it’s time for us physicians to help increase the number of lives saved by co-prescribing naloxone when it is clinically indicated. The AMA has resources that can help provide more information.

At the end of the day in Charleston, we all were energized by the partnership and alignment on what needs to be done to help end the nation’s opioid epidemic. Through our ongoing advocacy and work with the AMA Task Force to Reduce Opioid Abuse, the AMA is committed to equipping physicians to accomplish these goals. I urge you to join us.

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A majority of opoid deaths from overdose are from heroin, 52% from national statistics I have read. This comes from the poppy area from Afghanistan/Pakistan. The moon and star trademark are Osama bin Laden's former company with several billion dollars of revenue flow per year. The Pakistani army brass and national leaders of both countries have their palms greased so that this continues. If we are serious about opioid deaths perhaps we should focus on the majority of cases, i.e. heroin. Disruption of the growth of poppies would entail war against those nations whose national leaders and military have a vested interest. The other choice is to legalize it, tax it, ensure standard medicinal potencies and treat it similar to alcohol. For those who are waging a vendetta against physician prescribing of opioids, it is important to remember that acetaminophen is a leading cause of liver failure leading to transplant, and NSAIDs lead to a significant rate of kidney injury. Opioids alone are safer drugs when not taken to excess than the current alternatives. If you give me a better, safer drug to use, I will prescribe it. Having spent my general surgery years at the University of Wisconsin which was a big transplant center, I saw too many devastating problems from acetaminophen and NSAIDs to believe that they are an acceptable alternative for long-term chronic pain.
Whenever there is a drumbeat promoting a particular problem, it often seems prudent to follow the money. Now that there are longer-acting, more difficult to abuse narcotics, it is certainly the desire of the manufacturers to promote utilization of their product. There is no better monopoly than one imposed by the Federal Government. Based on prior drumbeats and an organized national project to create public awareness, it would not surprise me to soon see an action which will "encourage" use of the new, expensive sustained-release narcotics with an implied penalty for continued use of the "dangerous narcotics."
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