AMA Survey Indicates M.D. Support for Measures to Address Opioid Epidemic
Abstract
The survey found that only 15 percent of respondents had received training in medication-assisted treatment, which is essential in certifying physicians to treat opioid addiction and opioid use disorder.
American physicians strongly support AMA recommendations for ending the nation’s opioid epidemic.
Those recommendations include improving state Prescription Drug Monitoring Programs (PDMPs), enhancing physician education, and removing barriers to care, especially to use of naloxone.
AMA, U.S. Governors Speak With One Voice on Opioid Epidemic
The nation’s opioid abuse epidemic has caught the attention of U.S. governors who teamed with the AMA in calling for concerted action to combat the rising incidence of opiate use and abuse.
“Governors and physicians find it unacceptable that nearly 30,000 Americans die each year from the misuse and abuse of prescription opioids and heroin,” said Gov. Charlie Baker (R-Mass.), chair of the National Governors Association Committee on Health and Human Services, Vice Chair Gov. Maggie Hassan (D-N.H.), and AMA Board of Trustees Chair-elect and psychiatrist Patrice Harris, M.D., M.A., in a joint statement released last month.
“To end this national epidemic that claims the lives of so many of our family members and fellow citizens, governors, physicians, state legislatures and other stakeholders must join together to take action,” the governors and Harris stated. “We agree that physicians who prescribe opioids and other controlled substances benefit greatly when they use prescription drug monitoring programs [PDMPs]. These databases—when effectively funded, maintained, and integrated into everyday practice—are a powerful tool to identify potential signs of opioid abuse, enhance patient care, improve prescribing practices, and signal when a patient may need treatment for a substance use disorder.
“We agree that education about effective pain management, substance use disorder, and related areas should begin in medical school and continue throughout a physician’s career. That means physicians who prescribe opioids and other controlled substances must be sure they have the most up-to-date training and education to prescribe and administer those substances safely and effectively. It is imperative we provide care for patients in pain. However, prescribing medications excessively or ‘just in case’ is not acceptable and continues to fuel this growing epidemic. Guidelines are an important tool to prevent overprescribing and identify the signs of addiction while meeting the needs of patients in pain. We must also ensure patient satisfaction surveys and accreditation standards are not contributing to the problem by encouraging unnecessary opioid prescribing.”
The joint statement also called for prioritizing treatment for substance use disorder, saying a lack of resources combined with too few physicians trained to provide medication-assisted treatment (MAT). Harris and the governors also said removing federal barriers to buprenorphine would go a long way toward closing that gap.
“The epidemic will continue to rage unless we expand our treatment systems and address the stigma that prevents so many individuals and families from seeking help,” they said. “In addition, we must continue to promote overdose prevention and education efforts. That includes increasing access to naloxone to reverse overdoses and save lives, as well as co-prescribing naloxone to those at risk of overdose. Prescribers have primary responsibility for ensuring patients understand that misuse of opioids can result in addiction, overdose, and death.”
A survey conducted by the AMA Task Force to Reduce Opioid Abuse indicated that 87 percent of responding physicians believe PDMPs help physicians become more informed about a patient’s prescription history. The survey also found that to further enhance this as a resource, physicians said PDMPs need to be integrated with electronic health records, provide real-time data, and add other key features to make them more useful.
(The survey was conducted for the AMA by TNS Global Research between November 13, 2015, and November 23, 2015. The sample size was 2,130 practicing U.S. physicians who provide a minimum of 20 hours a week in direct patient care, have a current DEA license to prescribe Schedule II controlled substances, and prescribe opioids on a weekly or more frequent basis. The sample included all practice settings and regions in the United States.)
“If a physician is considering prescribing an opioid—whether for acute or chronic pain—we strongly encourage physicians to ensure that they are current in their knowledge and training as to when an opioid is appropriate—and when it is not,” said AMA President Steven J. Stack, M.D., in a statement. “This new survey helps underscore that medical societies must be leaders in providing the best resources possible to our colleagues in every state and for every specialty, both for appropriate opioid prescribing and in urging physicians to register for and use PDMPs.”
In related news, the AMA and leaders of the National Governors Association signed a joint statement calling for concerted action to end the nation’s opioid epidemic (see box on page 32).
The AMA survey also found that a majority of respondents have taken continuing medical education (CME) on safe opioid prescribing (68 percent) and pain management with opioid alternatives (55 percent). Moreover, the survey found that physicians want more practice-specific and specialty-specific education—1 in 4 physicians said that CME on these issues either was not readily available for their specialty or did not directly address their practice needs.
Only 15 percent of the respondents had taken courses on medication-assisted treatment (MAT). The AMA Task Force to Reduce Opioid Abuse has made increasing access to MAT a priority, and several medical organizations, including APA, offer training in MAT (see story on page 37).
In addition, the survey found strong support for increasing access to naloxone. More than 80 percent of the respondents said that naloxone should be available to a patient via a standing order or collaborative practice agreement with a pharmacist.
The AMA has model legislation that includes support for standing orders, and the AMA also has supported more than 20 state laws that increase access to naloxone in the community. Additionally, the AMA believes that it is essential that pharmaceutical companies and health plans ensure easy, reliable, and affordable access to this lifesaving medication.
“The next step to help increase access to naloxone is for physicians to co-prescribe this lifesaving medication to patients at risk of overdose,” said Stack. “Just as we would co-prescribe an epi-pen to a person at risk for a life-threatening allergic reaction, we should co-prescribe naloxone to a patient at risk for overdose.” ■
