On Oct. 19, the AAFP sent a letter(3 page PDF) to the President's Commission on Combating Drug Addiction and the Opioid Crisis(www.whitehouse.gov) offering the Academy's perspective on recommendations in the draft interim report(www.whitehouse.gov) the commission released on July 31 and highlighting the AAFP's work to combat the U.S. opioid misuse epidemic.
Addressed to New Jersey Gov. Chris Christie, who chairs the committee, and Richard Baum, M.P.A., acting director of the Office of National Drug Control Policy, the letter is intended to inform the commission's final report on opioids, which is scheduled to be released later this fall, as well as the 2018 National Drug Control Strategy.
The letter, which was signed by AAFP Board Chair John Meigs, M.D., of Centreville, Ala., opened by acknowledging the longstanding use of these drugs to treat pain despite limited evidence of their long-term benefit and an increasing body of evidence describing their risks.
"As a result of limited science, external pressures, physician behavior and pharmacologic development, we have seen the dramatic consequences of opioid overprescribing, misuse, diversion and dependence," the Academy said in its letter.
- The AAFP recently wrote to the President's Commission on Combating Drug Addiction and the Opioid Crisis about its ongoing work to fight the opioid epidemic.
- Among those highlights: AAFP members reported completing more than 141,000 CME credits on opioids in 2016.
- The Academy also expressed support for expanded access to medication-assisted treatment, standing orders for naloxone and bolstering state prescription drug monitoring programs.
The AAFP applauded the administration's efforts to promote policy to prevent the misuse of prescription opioids.
"Family physicians recognize that the increase in nonmedical use of these drugs has created a grievous public health crisis, and the AAFP is actively working to address the intertwined challenges of chronic pain management and opioid misuse," the letter noted.
"We support increased access to treatment for substance use disorder and concur with the commission's draft recommendation to rapidly increase treatment capacity and eliminate barriers to treatment resulting from the (Institutions) for Mental Diseases exclusion within the Medicaid program."
According to the letter, family physicians conduct about one in five medical office visits in the United States -- more than 192 million total visits a year -- and must balance caring for patients with chronic pain with appropriately prescribing opioids.
"In the face of opioid misuse, family physicians have a unique opportunity to be part of the solution," said the AAFP. "Both pain management and dependence therapy require patient-centered, compassionate care as the foundation of treatment. These are attributes that family physicians readily bring to their relationships with patients."
On Oct. 26, President Donald Trump signed an order directing acting HHS Secretary Eric Hargan, J.D., to use his authority under the Public Health Service Act to declare the nation's opioid addiction and misuse crisis a public health emergency.
It's a move the President's Commission on Combating Drug Addiction and the Opioid Crisis had urged in its draft interim report(www.whitehouse.gov) presented July 31.
Citing the 64,000 lives lost to opioid misuse in 2016, Trump noted in remarks he made before the signing(www.whitehouse.gov) that "drug overdoses are now the leading cause of unintentional death in the United States by far. More people are dying from drug overdoses today than from gun homicides and motor vehicles combined."
Although Trump's order does not permit HHS to tap into the Federal Emergency Management Agency's Disaster Relief Fund -- as a national emergency declared under the Stafford Act would -- it does enable Hargan to immediately take a number of specific actions to fight the opioid epidemic, such as expanding access to telemedicine in rural areas, instructing affiliated agencies to curb bureaucratic delays in dispensing grant money and shifting some federal grant monies toward combating the crisis.
The AAFP welcomed the president's move for highlighting the need for a coordinated response to the crisis, and noted that success will require adequate resources.
"We look forward to working with the Trump administration to identify the funding necessary to support a comprehensive and meaningful response that ensures appropriate pain treatment, prevents misuse and responds effectively to addiction disorders,” AAFP President Michael Munger, M.D., of Overland Park, Kan., said in a statement.
As a further element of being part of the solution, family physicians are committed to "fine-tuning their ability to prescribe opioids appropriately and effectively," said the letter. For example, AAFP members reported completing more than 141,000 CME credits on opioids in 2016.
"The AAFP continues to believe educating physicians is an important tool," the Academy noted, "but to be impactful, the education must be evidence-based and designed to address needs and gaps of the learners. 'One size fits all' education is not optimal.
"Requiring all physicians, or 'prescribers' in this case, to complete the same education, regardless of whether a relevant performance gap in this area exists, would be a disservice to that physician and their patients since it will result in unnecessary time spent away from patient care."
Mandated CME also isn't ideal because it limits family physicians' ability to complete other relevant education focused on specific learning needs and gaps, the AAFP said.
Increasing Treatment Access and Support
The Academy also expressed support for expanded access to medication-assisted treatment (MAT), standing orders for naloxone, and bolstering state prescription drug monitoring programs (PDMPs).
Greater access to MAT has long been a priority for the AAFP. For example, in 2013, the Academy wrote a letter(1 page PDF) to the DEA calling for lifting the addiction treatment cap in primary care from 100 to 200 patients.
"We saw the 100-patient limit as an impediment to expanding opioid addiction treatment and appreciate that the commission's draft recommendations include a federal incentive to enhance access to MAT," said the letter.
Another of the commission's initial recommendations -- to craft model legislation to allow naloxone dispensing via standing orders -- likewise received a thumbs up.
"The AAFP also supports expanded access to naloxone and appropriate Good Samaritan protections for the prescribers and lay rescuers who deploy this life-saving drug," said the letter.
Furthermore, the Academy backed the commission's recommendation for funding and technical support for effective state PDMPs capable of exchanging information across state lines, as called for by the National All Schedules Prescription Electronic Reporting Act. (www.nasper.org)
"We urge physicians to use their PDMP before prescribing any potentially abused pharmaceutical product," said the AAFP's letter. "However, the success of such efforts depends on state reporting systems that are accessible, timely and interoperable.
"We must work together to make PDMPs effective for the sake of the public health. The AAFP and our 55 chapters will continue working to bring localized and state-specific education to our members and their care teams."
Importance of Confidentiality
Regarding the commission's suggestions for better aligning patient privacy laws specific to addiction with provisions of the Health Insurance Portability and Accountability Act, the AAFP referenced its April 2016 letter(3 page PDF) to the Substance Abuse and Mental Health Services Administration (SAMHSA), in which it supported the proposed rule to update so-called Confidentiality of Alcohol and Drug Abuse Patient Records regulations.
That previous letter noted that the Academy "fully shares SAMHSA's goal to ensure that patients with substance use disorders have the ability to participate in, and benefit from, new integrated health care models without fear of putting themselves at risk of adverse consequences."
The Oct. 19 letter cited the AAFP's policy on patient/physician confidentiality, as recognizing that "a confidential relationship between physician and patient is essential for the free flow of information necessary for sound medical care."
"We believe that patient confidentiality must be protected, (although) we recognize that data-sharing between treating physicians, though difficult with current health record technology, is essential," the letter said. "Any disclosure of medical record information should be limited to information necessary to accomplish the purpose for which disclosure is made. Physicians should be particularly careful to release only necessary and pertinent information."
AAFP Opioid Resources
The letter concluded by highlighting the AAFP's member resources on pain management and opioid abuse, including its updated position paper, "Chronic Pain Management and Opioid Misuse: A Public Health Concern."
In addition, the Academy described its chronic pain management toolkit, noting that, "The AAFP encourages practices to use the toolkit to evaluate current policies regarding pain management and opioid prescribing."
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