opinion

A multipronged approach to opioid safety

The AMA is engaging with all key players through a range of education and advocacy efforts to combat prescription drug abuse while preserving necessary patient access.

Posted July 29, 2013.

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Promoting appropriate pain management for patients can be a high-wire act. Lean too far toward cracking down on prescription drug abuse and diversion, and the balance might be tipped in a way that endangers patients who legitimately need pain medicine as part of their care plans.

Physicians especially understand the importance of taking carefully considered steps to avoid crossing that tipping point. It’s one thing to oppose the deadly problem of abuse and diversion of opioids and other controlled substances; it’s another thing to have a comprehensive, rational plan to take on the challenge in a way that strikes the balance perfectly.

The American Medical Association is approaching the issue of opioid safety in just such a way. Through strategic engagement with all of the issue’s key players, both inside and outside of medicine, the Association has been helping to fight the abuse problem while continuing to serve the vital interests of physicians and patients.

Education of physicians is one key aspect of this multipronged approach. Pain medication use is not just a complex subject, it’s also a constantly evolving one. That’s why the AMA in late June started offering an updated pain management continuing medical education program that marshals the very latest knowledge and resources.

The program’s 12 modules cover a wide range of clinical topics for doctors looking to take multidisciplinary approaches to treating the tens of millions of patients with chronic pain. They include education on following the universal precautions approach to opioid analgesics as well as structuring therapy to manage the drugs’ risks. The program complements webinars on responsible opioid prescribing that the AMA has offered and will continue to offer over the coming years.

Updating the pain management education program was a true team effort, relying on funding from a group of health care organizations led by the American Academy of Addiction Psychiatry, using federal grant money.

The team concept also has been in play for another key aspect of the AMA’s approach — advocacy. After all, educating physicians is not going to be sufficient on its own to ensure that pain management can occur without enabling drug abuse. The advocacy effort has been marked by engagement with federal and state governments and agencies, as well as with such key players as the National Governors Assn., the National Conference of State Legislatures, the Federation of State Medical Boards, the National Safety Council and the National Conference of Insurance Legislators, among many others.

In its work with these governments and groups, the AMA has promoted comprehensive, rational advice on how policymakers should approach pain medication abuse. The recommendations cover a wide range of relevant topics, including prescription drug monitoring programs, substance abuse treatment and recovery programs, drug labeling, epidemiological data sharing, and drug disposal requirements.

Just as with the overarching issue, approaching some of these topics requires a balanced, nuanced approach. Physicians recognize, for instance, that the use of state prescription drug monitoring programs, if appropriately implemented and maintained, can be a powerful clinical tool to detect the kind of doctor shopping that signals prescription drug abuse and diversion. But employing a one-size-fits-all approach to how physicians must utilize PDMPs, without paying adequate attention to the systems’ data quality and distinctions among individual practices, will not be an effective intervention.

Similarly, focusing primarily on stemming prescription drug abuse without paying enough attention to possible downstream effects would leave wide gaps in the approach. Heavily regulating the prescription side while shortchanging efforts to prevent illicit drug use and addiction treatment, for example, could prove deadly as more people move from opioids to heroin and other substances. Food and Drug Administration labeling changes based on good evidence can help guide appropriate prescribing, but nonscientific label revisions aimed only at reducing utilization will have a negative impact on patients and prescribers.

The multipronged engagement on these issues by the AMA is a sensible one that already is paying dividends. The Association’s advocacy on naloxone and other opioid antagonists utilized to prevent overdose death, for instance, has helped enact several state laws encouraging the use of the treatments while providing liability protections for prescribers.

By tackling the opioid use and abuse issue from all sides, with all available partners and using the finest resources, the AMA has and will continue to make a major difference.

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