State Legislative Conference

1. Patrice A. Harris, MD, MA, FAPA
Immediate Past Chair AMA Board of Trustees
Chair, AMA Opioid Task Force
November 2017
Physicians as Leaders and Partners
in Reversing the Nation’s Opioid
Epidemic

2. © 2017 American Medical Association. All rights reserved.
Opioid-related mortality in the United States, 2012-2015
2
0
10,000
20,000
30,000
40,000
50,000
60,000
2012 2013 2014 2015 2016
Natural and Semisynthetic
Opioids (e.g. oxycodone,
hydrocodone)
Synthetic Opioids, other than
Methadone (e.g. fentanyl,
tramadol)
Heroin
Total Opioid Overdose Deaths

3. National Opioid-Related Inpatient Hospitalizations and ED
Visits

4. © 2017 American Medical Association. All rights reserved.
• Increase registration and use of PDMPs
• Ensure safe, evidence-based prescribing
• Support comprehensive pain care; reduce the stigma of pain
• Reduce the stigma of substance use disorder; increase access to
treatment
• Increase access to naloxone to save lives from overdose; support
broad Good Samaritan protections
• Promote safe storage and disposal of opioids

5. © 2017 American Medical Association. All rights reserved.

6. © 2017 American Medical Association. All rights reserved.
PDMP use increasing; opioid supply decreasing
6
0
20,000,000
40,000,000
60,000,000
80,000,000
100,000,000
120,000,000
140,000,000
Queries 2014 Queries 2015 Queries 2016
PDMP queries by health care professionals
259
251.8
244.5
227.8
215.5
2012 2013 2014 2015 2016
Total opioid Rx (millions)
Source: AMA survey of state PDMP administrators Source: QuintilesIMS

7. © 2017 American Medical Association. All rights reserved.
Prescriptions dropping across specialties …

8. © 2017 American Medical Association. All rights reserved.8
0
50,000,000
100,000,000
150,000,000
Queries
2014
Queries
2015
Queries
2016
PDMP queries by health care
professionals
259
251.8
244.5
227.8
215.5
2012 2013 2014 2015 2016
Total opioid Rx (millions)
• 118,000+ physicians
taking opioid-related
education
• 32,000+ naloxone Rx
dispensed Jan-Feb 2017
• More physicians trained
to treat substance use
disorders
• 13,000+ physicians
became certified to
provide buprenorphine
in past year

9. © 2017 American Medical Association. All rights reserved.
AMA Opioid Task Force recommendations
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10. © 2017 American Medical Association. All rights reserved.
www.end-opioid-epidemic.org
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11. © 2017 American Medical Association. All rights reserved.
https://www.end-opioid-epidemic.org/societies/aafp/
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12. Reduce the stigma of substance use disorder; increase access to
treatment
1. Stigma – misunderstanding of the disease
2. Capacity – lack of trained and willing providers
3. Access – treatment limits imposed by policymakers & insurers
“Over the last decade, the vast
majority ― about 8 in 10 ― of
all individuals with an opioid
use problem were not receiving
any treatment at a given point
in time, and rates of treatment
did not improve over the
decade despite a dramatic
increase in deaths related to
prescription drugs.”
- Brendan Saloner, PhD
Saloner B and Karthikeyan S. Changes in Substance Abuse Treatment Use Among Individuals With Opioid Use Disorders in the United States,
2004-2013. JAMA. 2015; 314(14):1515-1517.

13. © 2017 American Medical Association. All rights reserved.
New practice landscape – what can we control?
• All 50 states and D.C. now have naloxone access laws
• Physician co-prescribing  needs to increase
• Pharmacies stocking naloxone  not always commonplace
• Insurance covering at affordable prices  very large concern
• Treatment for substance use disorders
• Physicians becoming trained for in-office buprenorphine  Yes!
• Payers removing administrative barriers  No…
• Opioid prescribing going down, but is care going up?
• Payers covering non-opioid and non-pharmacologic options  ???
• Is the practice environment supportive of pain care  ???

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Which guideline is a physician supposed to follow?
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15. The road ahead …
• Enforce existing laws
• Build new partnerships
• Coalitions at the state level
 State Attorneys General
 Insurance Commissioners
• Let data/trends inform policy

17. © 2017 American Medical Association. All rights reserved.
Goals of presentation
• Explain the role of the AMA Opioid Task Force
• Identify the actions that physicians can take—and have taken—to end the
epidemic
• Show the data associated with physician responses to those policies
• Highlight some of the challenges we collectively face to reverse the epidemic
• Raise questions for your consideration
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