With 44 people dying every day from overdose of prescription painkillers in the United States and many more becoming addicted, opioid abuse in the country has reached a critical level.
Recognizing the urgency of this epidemic and the effect it has on patients across the country, the AMA Task Force to Reduce Opioid Abuse(www.ama-assn.org) released the first of several national recommendations to address this growing epidemic on July 29.
Comprising 27 physician organizations including the AAFP, the task force was formed in 2014 to identify best practices to combat opioid abuse and to swiftly implement these practices in offices across the United States.
"Prescription painkillers present a tough issue for physicians. We want to make sure that patients who suffer from chronic pain are able to get the care they need, but at the same time, we have to do everything we can to prevent addiction and overdose," said AAFP President Robert Wergin, M.D., of Milford, Neb., in a statement. "That’s why we’ve joined this task force -- opioid abuse has become a public health epidemic that must be stopped."
The task force will initially focus on urging physicians to register for and use state-based prescription drug monitoring programs (PDMPs) as part of their decision-making process when considering treatment options.
- The American Medical Association Task Force to Reduce Opioid Abuse released the first of several national recommendations to address the urgent drug abuse epidemic on July 29.
- Comprised of 27 physician organizations including the AAFP, the task force was formed in 2014 to identify best practices to combat opioid abuse and to swiftly implement these practices in offices across the United States.
- The task force initially will focus on urging physicians to register for and use state-based prescription drug monitoring programs as part of their decision-making process when considering treatment options.
"PDMPs vary greatly in efficacy and functionality from state to state," said AMA Board Chair-elect Patrice Harris, M.D., M.A., in a press release(www.ama-assn.org). "Alone, they will not end this crisis, but they can provide helpful clinical information, and because they are available in nearly every state, PDMPs can be effective in turning the tide in the right direction to end opioid abuse."
The new initiative also seeks to significantly enhance physicians’ education on safe, effective and evidence-based prescribing with an online resource(www.ama-assn.org) that offers information on PDMPs, the risks and benefits of prescribing opioids, managing pain, treating substance use disorder and overdose prevention.
Robert Rich, M.D., chair of the AAFP Commission on Health of the Public and Science and the Academy's representative on the task force, told AAFP News that this effort by the group of physician organizations is important because "there simply are not enough pain specialists to treat all the chronic pain patients out there and the health care system cannot absorb the costs associated with treatment of all chronic pain patients by specialists."
Rich said that while the task force is not developing actual guidelines for pain care, the group has researched the general tools used by various state and specialty society guidelines for pain care and developed position statements about these tools including their adoption by primary care providers, funding for use and suggested model attributes.
"The task force has advocated for the promotion and use of those tools, particularly when supported by evidence-based research and when mechanisms exist to enable easy adoption by primary practices," he said.
Many states have already implemented PDMPs, which allow primary care providers to access their patient's fill history of controlled medications including prescription opioids and benzodiazepines, Rich said.
When PDMPs are fully funded, contain relevant clinical information and are available at the point of care, they have been proven to be an effective tool to help physicians identify patients who may be misusing opioids, and to implement treatment strategies including referral for those in need of further care, according to the AMA's news release.
"To be useful to the practicing physician, the information contained in the PDMP must be accurate and up to date, easily accessed by the physician and/or a designated staff member, linked to the PDMPs in neighboring states and the information contained in the PDMP easily populated by the practicing pharmacist, who is often tasked with entering that information manually," Rich said.
He added that the task force recognizes that the information contained in PDMPs still varies significantly from state to state, and it is advocating for the proper funding and standardization of PDMP efforts by state and federal authorities.
"I practice in a state that has had a functioning PDMP for several years and on more than one occasion, I have been surprised by the information contained in that PDMP," Rich said, "including the patient who was obtaining opioid pain relievers from several providers in violation of my pain contract with that patient as well as the patient that I was convinced was obtaining opioids from several providers but who was compliant with the terms of their pain contract when the PDMP was accessed on serial visits."
Working on Additional Efforts
The task force also is working on other efforts, including providing prescribers with evidence-based education and training to enhance safe prescribing for patients who need opioid pain relievers.
In addition, the group is looking to improve efforts to provide comprehensive pain care including the use of ancillary strategies so that patients with pain needs will seek that care without feeling stigmatization, Rich said.
The task force also is examining how to best improve the diagnosis of substance use disorder and improve access to evidence-based treatment for those patients. And finally, the group is promoting expanded use of naloxone for patients who are at risk of overdose from opioids including provision of bystander-administered naloxone, which is now available in certain states.
"Hopefully, (AAFP) members will access these resources (once they are available) and then critically assess their internal policies and procedures to see how they can improve the management of their chronic pain patients," Rich said.
He added that he also envisioned AAFP members using the Academy's pain management resources including its position paper "Pain Management & Opioid Abuse" and American Family Physician's AFP by Topic Chronic Pain resource to enhance their chronic pain care and safe opioid prescribing.
Since the task force's creation, Rich said, the group has repeatedly been reminded of the proposed and enacted efforts by state and federal governments to deal with the problem of prescription opioid abuse.
"Accordingly, the task force has worked to provide leadership in the development of the policies and statements that would address those concerns with the least impact on providers and our patients, otherwise our governmental officials will do it for us," he said.
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