AMA Delegates Vote to Add Naloxone to Opioid Rx
The American Medical Association (AMA) adopted new policies at its annual meeting to help reverse the growing epidemic of opioid overdose (from heroin and prescription opioids) and abuse. The new policies encourage physicians to:
- Co-prescribe naloxone to patients at risk of an overdose
- Promote timely and appropriate access to non-opioid and non-pharmacologic treatments for pain
- Support efforts to delink payments to health care facilities with patient satisfaction scores relating to the evaluation and management of pain.
“The AMA and our nation’s physicians have demonstrated our commitment to ending this epidemic,” said Patrice A. Harris, MD, chair-elect of the AMA and chair of the AMA Task Force to Reduce Opioid Abuse. “These new policies build on the work of our task force, which has made clear that physicians must take a leading role in reversing the tide of this epidemic.”
Practical Pain Management spoke with Dr. Harris in March, 2016 about her work leading a taskforce to reduce opioid abuse. In that interview, Dr. Harris noted that she has been a strong advocate for the widespread adoption of Prescription Drug Monitoring Programs (PDMPs) and a proponent for providing more educational resources for physicians to develop safe prescribing practices.
Despite the recent Food and Drug Administration approval of an auto-inject (Evzio) and intranasal-spray version (Narcan) of naloxone, many physician have been reluctant to prescribe naloxone along with an opioid prescription.
AMA Annual Meeting
A panel discussion on opioids led by Dr. Harris at the annual meeting, which was held in Chicago, asked the question: with 78 opioid-related deaths a day, what can one physician do? The experts recommendations also included how to more effectively use prescription drug monitoring programs.
The new naloxone policies will increase access to the overdose-reversing drug for friends and family members of patients at risk of overdose, noted a press release from the AMA.
The policy also encourages private and public payers to include all forms of naloxone on their preferred drug lists and formularies with nominal or no cost sharing. The policy supports liability protections for physicians and other authorized health care professionals to prescribe, dispense, and administer naloxone.
Delegates at the annual meeting also called for policies to enable law enforcement agencies to carry and administer naloxone. Naloxone laws have been enacted in 25 states across the country. These laws allow protection for first responders—such as police and firefighters—as well as friends, family, or clinicians who administer the opioid antagonist in cases of overdose.
The policy calls for “collaborative practice agreements” with pharmacists, as well as standing orders for pharmacies, where permitted by law. It also advocates for availability of naloxone to community-based organizations, law enforcement agencies, correctional settings and schools.
“These policies will save lives. That’s the bottom line,” Dr. Harris said. “Time and time again, we have seen naloxone save lives once it is in the hands of first responders. We just have to make sure that we are co-prescribing it when clinically indicated, and that it is affordable for the community and available at local pharmacies.”
Delegates adopted a policy that calls on the AMA to oppose efforts that would arbitrarily restrict a patient’s ability to receive effective, patient-specific, evidence-based pain care, noted the AMA.
“Patients in pain need comprehensive care and compassion. When proposing treatments, we must ensure that policies are grounded in science.” Dr. Harris said. “Also, insurers must cover non-opioid and non-pharmacologic therapies that have proved effective. Insurers must take a broader view to give patients and physicians more choices.”
Delegates also recommended breaking the link between patient satisfaction surveys of pain treatment and payments to facilities. Supporters said eradication or total resolution of a patient’s pain is often misguided and puts inappropriate pressure on clinical pain management practices that can encourage the overuse of opioids, especially since other approaches are not covered by insurance.
“Treating pain is a priority for physicians, and we know that there are many ways to do it. We must ensure that patients have access to comprehensive pain care as well as reduce the stigma of pain,” Dr. Harris said. “Judging health care facilities on an overly subjective measure – that is, how well it is perceived that they treat pain -- is an overly simplistic approach to measuring clinical effectiveness.”
The AMA also adopted policy supporting the American Board of Preventive Medicine’s (ABPM) establishment of addiction medicine as a multispecialty-sponsored subspecialty, according to a press release from the AMA. The new subspecialty was approved by the American Board of Medical Specialties (ABMS) and will be available to qualified physicians who are diplomates of any of the 24 ABMS member boards. "The policy adopted also encourages ABPM to expeditiously offer the first addiction medicine certification examination to physicians," noted the AMA.
“We applaud the American Board of Preventive Medicine for establishing addiction medicine as a new subspecialty because we believe that having more physicians specifically trained to treat addiction will help improve access to care and help combat the nation’s opioid epidemic,” said Dr. Harris.
Creating a Program to Dispose of Unwanted Medications
With a flood of unused medications already in circulation, the AMA called for the pharmaceutical industry to fund a program to dispose of unwanted medications as hazardous waste. "Estimates indicate that between 30% and 80% of patients do not finish prescriptions for common medication, including pain medication. Many of these drugs are discarded at home," where they can be accidental misused or stolen for abuse, noted the AMA.
Improper disposal of medications is not only dangerous for family members, but the US Geological Survey sampled rivers and streams and found that up to 80% showed traces of drugs, hormones, steroids, and personal care products.
“Many of these unused medications, most notably opioids, are diverted and used by someone other than the patient,” said AMA President-Elect David O. Barbe, MD. “Manufacturers should be stewards of their products throughout their lifecycle and provide this critical service to patients and our environment.”