The public has become increasingly aware of the opioid addiction crisis in the United States, increasing pressure on lawmakers and public health officials to take action. In 2013, more than 16,000 people died from prescription opioid overdose, which is greater than any other drug, according to a report from the Johns Hopkins University School of Public Health. An estimated 2.1 million Americans are addicted to opioid pain relievers, making this an epidemic of unprecedented proportions.
American Medical Association Toolbox to Counter Opioid Addiction
Physicians have been at the forefront of the debate surrounding opioid abuse and addiction. Many people in the public believe that physicians have engaged in vast overprescribing of prescription drugs, causing patients to become addicted to these substances. In response, the Centers for Disease Control and Prevention released prescribing guidelines for physicians to curb the widespread overuse of prescription opioids. The American Medical Association (AMA), the primary physician professional and advocacy organization, has been integral in organizing doctors to combat the opioid epidemic. The AMA believes that overprescribing is just one piece of the puzzle. In their annual meeting last week, the AMA adopted new policies to address the problem of opioid abuse in the United States. This AMA Toolbox includes the following measures:
- Co-prescription of naloxone with prescription opioids for patients who may be at higher risk of overdose. Naloxone is an opioid antagonist that can rapidly reverse the effects of overdose. It has been successfully used to save the lives of people undergoing overdose.
- Promoting better access to non-opioid or non-pharmacologic treatments for pain.
- Calls for law enforcement agencies to be permitted to carry and administer naloxone to individuals undergoing overdose.
- Increased collaboration with pharmacies to monitor prescription drug use.
- Eliminating the link between patient satisfaction ratings of pain treatment with payments to health care facilities. The AMA argues that these measures put undue pressure on physicians to prescribe opioids to ensure reimbursement by insurance companies.
Evaluating These Tools for Use in the Opioid Epidemic
These tools represent a great step forward in the fight against opioid abuse. Let us touch on a few of these tools.
Prescription Drug Monitoring Program
In particular, the toolbox calls for states to provide a prescription drug monitoring program (PDMP). PDMPs are electronic databases that hold information about physician prescribing practices as well as the specific opioid history for each patient. This allows physicians to quickly access information about a patient’s opioid use history, allowing them to make more informed judgments about whether to prescribe opioids to that person. It also helps doctors identify people who may be in need of a co-prescription of naloxone or a referral for opioid abuse treatment. Unfortunately, even states that do have monitoring programs often have not adequately funded these databases. Additionally, unless a PDMP is integrated into a physician’s workflow, the database will remain underutilized and ineffective.
Promoting better access to non-opioid or non-pharmacologic treatments for pain
The call for physicians to make greater use of non-opioid pain management strategies is another welcome step in the fight against prescription opioids. Opioid painkillers can be helpful for acute pain, but they may be dangerous for patients suffering from chronic pain. Eventually, patients will develop some level of physical dependence on opioid medications. Additionally, some patients go on to develop addiction, characterized by drug-seeking behavior and strong drug cravings. There is a variety of alternative pain management strategies that can be helpful for patients. This may include non-opioid medications, physical therapy, therapeutic massage, acupuncture, or biofeedback. Improving physician education about these alternative pain management modalities can help them better advise patients about their options.
Co-prescription of naloxone with prescription opioids
Finally, the AMA calls for greater access to naloxone, an opioid antagonist that reverses the effects of overdose. Access to naloxone varies by state. The AMA encourages states to make naloxone widely available and enact “good Samaritan” protections to prevent individuals who provide assistance to an overdosing person from facing legal action. The new AMA policy is a step in the right direction in the fight against opioid abuse. However, it is also important to highlight the need for greater access to effective treatments to combat opioid dependence and addiction. Many patients are suffering from emotional and psychological problems that keep them stuck in a pattern of maladaptive opioid use. Providing greater access to opioid detox and addiction treatment can help to save the lives.
The Prescription Opioid Epidemic: An Evidence Based Approach, Johns Hopkins Bloomberg School Of Public Health. Retrieved on 06/21/2016.