What makes it important is its comprehensiveness. The team at Hopkins attacks the issue at every step in the drug distribution value chain: prescribing guidelines, prescription drug monitoring databases (PDMPs), pharmacy benefit managers (PBMs) and pharmacies, overdose and addiction, and community based prevention strategies.
The document is the summation of work performed by seven sub-committees that discussed, debated, and deliberated the options for addressing opioid misuse and abuse. The committees were made up of experts in the field and the passion, commitment, and resolve of these individuals is apparent in the resulting recommendations.
Perhaps most impressive, the paper appears to leave politics aside (as any good public health institution should) and advocates for specific tactics that have long faced strident opposition from well-funded groups. Specifically, the paper calls for mandatory prescriber education and mandatory prescriber use of PDMPs... the American Medical Association has pushed back on the former and while they've recommended the latter, many state level medical associations have balked at mandatory PDMP use.
The paper should also be commended for suggesting innovative (though controversial) ideas, such as:
- Authorize third party payers to access PDMP data with proper protections
- Require oversight of pain treatment (through mandatory tracking of pain, mood, and functionality at each patient office visit)
- Empower licensing boards and law enforcement to investigate high risk prescribers
- Require that federal support for prescription drug misuse, abuse, and overdose interventions include outcome data
Work like this gives me hope.
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