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Monday Dec 21, 2015

Government Hears From FPs on Opioid Abuse Crisis

In the 1990s, physicians were told we weren't doing enough to address pain. Millions of Americans were suffering with chronic pain, affecting more patients than diabetes, heart disease and cancer combined(www.report.nih.gov). Essentially, we were told we were failing these patients.

Naturally, physicians responded.

© 2015 Shawn Martin/AAFP

Here I am with Surgeon General Vivek Murthy, M.D., M.B.A. Murthy gathered a group of stakeholders Dec. 16 in Washington to address prescription painkiller abuse.

In 1995, the American Pain Society introduced the slogan "Pain: the fifth vital sign," to raise awareness of the need to treat pain. By 1999, the Joint Commission on Accreditation of Healthcare Organizations was on board as well, and that organization published new standards for pain management a year later.

Unfortunately, the pendulum has swung too far. The number of prescriptions written for opioids jumped from 87 million in 1995 to 219 million in 2011(www.drugabuse.gov). From 2003 to 2013, the number of Americans who died as a result of opioid abuse surged from 4.5 per 100,000 to 7.8 per 100,000(jama.jamanetwork.com). In 2014, 19,000 people died(www.ncadd.org) as a result of such abuse.

Now we find ourselves in a difficult situation as federal agencies ask us to curb our prescribing at the same time that our patients are living longer and with more chronic conditions. How do we find a balance and bring that pendulum back to the middle?

Last week I devoted an entire day in Washington to this issue, meeting with staff members from the offices of Sens. Pat Toomey, R-Pa., and Bob Casey, D-Pa., speaking with a national media outlet and participating in a meeting called by the surgeon general.

Toomey and Casey, senators from my state, are hearing a lot from federal agencies, the public and the medical community, and they are trying to determine whether there is a legislative solution. I made them aware of the delicate art and science of caring for patients in pain, and the work that family medicine and AAFP have been doing to curb opioid diversion and deaths.

I also spoke with National Public Radio host Robert Siegel for an upcoming segment of All Things Considered that focuses on our nation's pain and opioid dilemma. One of the things he asked me was how often family physicians have to deal with the issue of pain.

As you know, every day we care for patients with pain because roughly 100 million Americans suffer from chronic pain(www.painmed.org). So we discussed how to decide who should be treated -- or not -- with prescription medications and what steps we can take to ensure that medications are used appropriately and only for as long as needed. I also highlighted the importance of having an ongoing relationship with a primary care physician.

Many of these same issues rose that day during an event organized by Surgeon General Vivek Murthy, M.D., M.B.A. In addition to the AAFP, representatives from many other health care groups -- including the American College of Physicians, American Congress of Obstetricians and Gynecologists, American Dental Association, AMA, American Osteopathic Association and American Association of Nurse Practitioners -- were present.
The day before this meeting, a study published in JAMA Internal Medicine(archinte.jamanetwork.com) reported that primary care professionals were the biggest prescribers of painkillers, with family medicine recording 15.3 million prescriptions, internal medicine 12.8 million, nurse practitioners 4.1 million and physician assistants 3.1 million. So you might have expected our specialty to be in the crosshairs during this meeting with federal officials.

However, HHS acknowledged that this is a public health issue that is multifactorial. We also agreed that it's not surprising that family physicians see a large number of patients suffering with chronic pain because FPs provide roughly one in five U.S. office visits.

It was refreshing that this event was essentially a listening session for the federal health agencies. We told them what we are experiencing and what needs to improve. For example, we talked about the importance of physicians participating in prescription drug monitoring programs (PDMPs), working with states to make PDMPs more robust when needed, using real-time data and achieving interoperability among state programs. We also discussed safety issues and the need to reduce diversion.

The CDC recently released a draft of its new guidelines for opioid prescribing(www.cdc.gov), and it's not yet clear what the surgeon general's next step will be. But we do know the AAFP will continue to work with the federal agencies, as our policy on this issue states, "to allow effective and safe opioid prescribing for patients in their pain management programs by their family physicians."

Wanda Filer, M.D., M.B.A., is president of the AAFP.

Posted at 05:04PM Dec 21, 2015 by Wanda Filer, M.D.

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