Monday, August 3, 2015

Necessary, but Insufficient: The AMA on Opioids

The American Medical Association has created a focused initiative to combat prescription drug misuse and abuse.  This is an encouraging step and I'm pleased to see this particular collection of healthcare associations, as invited by the AMA board of trustees, entering the fray with what appears to be real intent to change practice patterns and educate physicians.  But they have a long way to go if they really want to make a difference.

The first step of the Opioid Abuse Task Force is to encourage physicians to register for and use state-based Prescription Drug Monitoring Programs (PDMPs).  This is a classic political gambit for a highly political organization.  Are PDMPs critical to the fight against prescription drug misuse and abuse?  Absolutely.  Will a focus on PDMPs, by itself, create the kind of lasting change we need in the area of chronic pain management?  Not a chance.  It's as if the Task Force gathered in a room and asked themselves, "What's the least controversial thing we can do that still has a chance to make an impact?"  Given that lens, this is a good start.  But that's not the right lens through which to view the largest man-made epidemic in history and the most pervasive public health crisis of our time.

Granted, the AMA has described this only as a first step.  But there are tough political and economic decisions that lie ahead if the AMA really wants to stem the tide of prescription drug misuse and abuse.  For instance:

Will the AMA support mandatory physician education on safe prescribing of opioids (and other potentially addictive medications)?  Will they support mandatory education on best practices in chronic pain management?

Will the AMA take a position against physician dispensing?  Among the most well-financed and well-organized opponents of legislation calling for bans and/or limitations on physician dispensing have been state-based medical associations.  The AMA has an opportunity to change the debate on this important topic.  Will they?

Will the AMA support efforts at the state level, across the payer spectrum, to deploy evidence based medical guidelines and create utilization review programs so that payers have the tools they need to ensure the medical necessity of prescription medications?

Will the AMA take a position on urine drug monitoring for chronic pain patients?  While a critical tool for ensuring patient compliance and preventing diversion, testing is often abused by physicians as a practice revenue generator.  Will the AMA work with the payer community to stop this and ensure the monitoring is used for medically necessary and clinically relevant purposes?  

The fight against prescription drug misuse and abuse is a tough one.  The AMA is going to have to come to the table with more than PDMPs.  I hope the next few steps in the Task Force plan show the political courage necessary to create lasting change.

On Twitter @PRIUM1

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