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Tuesday Aug 04, 2015

Country in Crisis: Addressing our Addiction Epidemic

In a recent speech(www.c-span.org) to the National Governors Association, HHS Secretary Sylvia Burwell laid out an aggressive strategy to combat our country's growing drug abuse epidemic. This issue is of great interest to the secretary. As a native of West Virginia, a state on the frontline of the issue, she has seen the impact that drug abuse -- both illicit and prescription -- has had on families and the state’s economy.  

This speech by Secretary Burwell is one of many recent activities that have raised awareness and a created a sense of urgency about drug abuse. The Obama Administration has made the issue a priority for its final two years, and the White House Office of Drug Control Policy released the National Drug Control Strategy: A 21st Century Approach to Drug Policy(www.whitehouse.gov). This policy outlines the expansive scope of this issue. The report outlines a number of policy proposals, many of which are consistent with AAFP policies. We have communicated our support for the proposal and have identified a series of collaborative activities we plan to pursue.

During the past few years, our nation has seen an increase in the prevalence of abuse of a number of legal and illegal substances, including prescription drugs. According to the CDC,  roughly 110 Americans died from drug poisoning every day in 2011. Prescription drugs were involved in more than half of the drug poisoning deaths that year. Sadly, these numbers are four years old, and the problem has grown worse.

The cost of addiction and abuse is startling. Although the majority of our attention is focused on opioid addiction, we should not overlook or underestimate the impact that all addictions have on the health of individuals, the health care system and the national economy.  

Since the “war on drugs” campaign, which was a cornerstone of the Reagan Administration, we have viewed the issue of drug abuse as a law enforcement issue. This trend has held consistent for much of the past three decades. To this day, the primary regulatory body that grants physicians prescribing rights for controlled substances is a law enforcement agency -- the DEA. However, we are in the midst of a gradual transition whereby we are beginning to view prescription drug abuse as a public health issue, not simply a law enforcement issue. This transition is important, and it would not have happened without the AAFP’s leadership and collaborative advocacy efforts with patient and public health organizations during the past decade.

The AAFP has been a national leader on the issues of pain management and opioid abuse. The AAFP policy paper “Pain Management and Opioid Abuse: A Public Health Concern” is a document that is widely regarded as instrumental to the current public discourse on this issue.  

It is important for us to all fully acknowledge that family physicians, collectively, prescribe a majority of opioids in this country. According to research conducted (pending publication) by the Robert Graham Center, more than 60 percent of all prescriptions for controlled substances provided to Medicare patients are written by family physicians. Researchers at the Graham Center(www.graham-center.org) estimate that the percentage in the non-Medicare population is likely higher, between 65 percent and 70 percent. However, it is important to note that family physicians diagnose and treat the majority of acute and chronic pain patients. Like most chronic conditions, family physicians are the primary providers of care to patients with chronic pain.  

Striking a balance between treating pain and appropriate prescribing is the primary reason this issue has become so complicated from a policy perspective. Although we should be diligent in our efforts to address what is a real and growing epidemic of prescription drug abuse, we should not underestimate the prevalence of acute and chronic pain and the need to ensure that family physicians are able to care for patients in a manner that is free of unnecessary regulatory compliance burdens.

It is estimated that 60 million Americans have some type of chronic nonmalignant pain, and the annual cost associated with all types of pain is estimated to be greater than $500 million per year. Given our aging population, we should anticipate that these numbers will increase in the next two decades.

The issue of substance and prescription drug abuse is ever-present for state governments and has emerged as a top policy issue for Congress and the Obama Administration.  Many states have seen dramatic increases in the number of individuals seeking treatment for substance abuse and, sadly, significant increases in the number of deaths from overdoses of legal and illegal substances. The negative economic impact of abuse on state budgets has become a frontline political issue in almost every state. 

In an effort to better monitor prescribing in their respective states, 49 states (Missouri is the hold out) have established prescription drug monitoring programs (PDMPs). Unfortunately, only 24 of the 49 PDMPs communicate with each other, leaving gaps in access to timely data that could assist physicians in making informed decisions.  

The AAFP consistently reiterates our commitment to work with federal and state governments to identify and implement a balanced approach to curbing the prevalence of prescription drug abuse while ensuring that physicians can continue to provide appropriate care to patients. A key component of our advocacy efforts is the work we are doing as part of the Task Force to Reduce Opioid Abuse, convened by the AMA.

The task force is compromised of the AAFP, the AMA, the American Dental Association and 25 other national and state physician organizations. The task force’s goal is to “significantly enhance physicians’ education on safe, effective, and evidence-based prescribing.”  On July 29, the task force released a series of policy recommendations. The task force organized its recommendations around five main goals:

  • Increase physicians’ use of effective PDMPs.
  • Enhance physicians’ education on safe, effective and evidence-based prescribing of opioids.
  • Reduce the stigma of pain and promote comprehensive assessment and treatment.
  • Reduce the stigma of substance use disorder and enhance access to treatment.
  • Expand access to naloxone in the community and through co-prescribing.

The AAFP remains dedicated to finding solutions to the crisis of pain management care and opioid abuse. Our policies are reflective of these two goals. Here are some key points from the Academy's policy paper, “Pain Management and Opioid Abuse: A Public Health Concern."

  • The AAFP advocates for increased national funding for research into evidence-based strategies for pain management and their incorporation into the patient-centered medical home model.
  • The AAFP urges states to obtain physician input when considering pain management regulation and legislation. 
  • The AAFP urges states to implement PDMPs and the interstate exchange of registry information as called for under the National All Schedules Prescription Electronic Reporting Act of 2005.
  • The AAFP opposes mandated CME as a prerequisite to DEA or other licensure due to the limitations on patient access to pain management. 
  • The AAFP supports development of evidence-based physician education to ensure the safest and most effective use of long-acting and extended-release opioids and to reduce the problem of opioid abuse. 
  • The AAFP will continue to work with appropriate government agencies to ensure policies are in place to allow effective and safe opioid prescribing by family physicians for patients in their pain management programs. 
  • The AAFP has a number of resources available related to this issue. 

Posted at 07:00AM Aug 04, 2015 by Shawn Martin

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ABOUT THE AUTHOR



Shawn Martin, AAFP Senior Vice President of Advocacy, Practice Advancement and Policy.

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The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. All comments are moderated and will be removed if they violate our Terms of Use.