American Medical Association Task Force to Reduce Opioid Abuse - Vision Session Presented by American Medical Association

1. AMA Task Force to Reduce Opioid Abuse
Patrice A. Harris, MD, MA
Chair-elect
American Medical Association
March 29, 2016

2. © 2015 American Medical Association. All rights reserved.
• AMA Task Force to Reduce Opioid Abuse
– 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
• www.ama-assn.org/go/endopioidabuse
2

3. © 2015 American Medical Association. All rights reserved.
Drug Poisoning Deaths Involving Opioid Analgesics and
Heroin: United States, 1999–2014
Sources: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Unintentional Injury
Prevention
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
opioid analgesics 4030 4400 5528 7456 8517 9857 10928 13723 14408 14800 15597 16651 16917 16007 16235 18893
heroin 1960 1842 1779 2089 2080 1878 2009 2088 2399 3041 3278 3036 4397 5925 8257 10574
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000
20,000

4. © 2015 American Medical Association. All rights reserved. 4

5. © 2015 American Medical Association. All rights reserved.
Increase registration and use of PDMPs
• Quickly and accurately access your patient's prescription history
• Support delegate(s) in your practice to access the PDMP
• Interstate interoperability
• Create alerts for your patients
• Contain referral information for co-occurring mental health or substance
use disorders
5

6. © 2015 American Medical Association. All rights reserved.
Physicians say that PDMPs can help provide important
information about a patient’s prescription history
6
4% 3%
8% 10%
45% 43%
42% 44%
Agree completely
Agree somewhat
Disagree somewhat
Disagree competely
Perceptions of state PDMPs in helping physicians to …
Be fully informed about your
patients’ prescription history
Identify when patients
receive multiple prescriptions
Agree
87%
Agree
87%

7. © 2015 American Medical Association. All rights reserved.
Ensure safe, evidence-based prescribing
• American Academy of Family Physicians
• American Academy of Hospice and Palliative Medicine
• American Academy of Pain Medicine
• American Academy of Physical Medicine and Rehabilitation
• American College of Emergency Physicians
• The American College of Physicians
• American Congress of Obstetricians and Gynecologists
• American Dental Association
• American Society of Anesthesiologists
• American Society of Addiction Medicine
• American Osteopathic Association
• American Society of Interventional Pain Physicians
7

8. © 2015 American Medical Association. All rights reserved.
Total Primary care Specialists
(2130) (1219) (911)
Safe opioid prescribing 69% 68%
Pain management with opioid alternatives 54% 56%
Treatment and prevention of substance use disorder 45% 35%
Prevention of diversion 30% 22%
PDMPs 17% 17%
Naloxone 16% 17%
Medication assisted treatment 14% 15%
Other 5% 5%
68%
55%
40%
26%
17%
17%
15%
5%
7 in 10 physicians took education on safe opioid prescribing, and
more than half on pain management with alternatives.
8
Education taken by physicians

9. © 2015 American Medical Association. All rights reserved.
Support comprehensive pain care; reduce the
stigma of pain
9

10. © 2015 American Medical Association. All rights reserved.
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.

11. © 2015 American Medical Association. All rights reserved.
Increase access to naloxone; co-prescribe naloxone;
support broad Good Samaritan protections
Questions for physicians to consider before co-prescribing or prescribing naloxone:
• Is my patient on a high opioid dose?
• Is my patient also on a concomitant benzodiazepine prescription?
• Does my patient have a history of substance use disorder?
• Does my patient have an underlying mental health condition that might make him or
her more susceptible to overdose?
• Does my patient have a medical condition, such as a respiratory disease or other co-
morbidities, which might make him or her susceptible to opioid toxicity, respiratory
distress or overdose?
• Might my patient be in a position to aid someone who is at risk of opioid overdose?
11

12. © 2015 American Medical Association. All rights reserved.
• AMA Task Force to Reduce Opioid Abuse
– 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
• www.ama-assn.org/go/endopioidabuse
12