Interview with AMA Task Force Chair Patrice A. Harris, MD, MA
A practicing psychiatrist based in Atlanta, Georgia, Dr. Harris 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.
A recent survey published by the AMA found a majority (87%) of 2,130 physicians agreed PDMPs can be useful for staying informed about patients’ prescription histories and identifying when patients are receiving multiple prescriptions. This was a positive consensus, considering 61% of the surveyed doctors reported prescribing opioids on a daily basis, commonly in primary care settings for noncancer chronic pain conditions.
“Doctors are certainly willing to check PDMPs and really want to use PDMPs as part of the decision making process regarding treatment decisions,” said Dr. Harris in an interview with Practical Pain Management. However, the surveyed physicians also agreed on a number of ways state-run PDMPs could be improved—like integrating the databases with Electronic Health Records (EHRs).
According to Dr. Harris, getting PDMPs interoperable with EHRs is a challenge, but it could be a major step forward towards making pertinent data easily accessible to practitioners when they need it to make important clinical decisions.
“I hear from physicians across the country as we’ve discussed this issue, where you may have a database for the PDMP and you may have a database for your hospital or your medical office, and then perhaps you might have to pull up a database to see what medications are authorized in that particular person’s insurer… so we really do need to stress that whenever we have any discussion around PDMPs, one of the key points needs to be how to integrate these into a physician’s workflow,” she said
With the advent of EHRs, physicians are spending more time than ever before computers updating patient information. Not surprisingly, the majority of surveyed physicians also agreed that PDMPs should feature patients’ complete prescribing histories, as well as provide real-time data entry from the pharmacists.
More Education Needed
Dr. Harris pointed out the majority of surveyed physicians were also in agreement that practitioners should receive further education on safe opioid prescribing and pain management alternatives. However, many physicians also reported not knowing where to access this information or find materials centered on their specialty.
Fostering education about these topics for physicians is one of the chief aims of the AMA’s Task Force, said Dr. Harris. The Task Force has culled together an extensive resource of training and educational resources on opioid prescribing topics that can be found on the AMA website, a “one-stop-shop” of general and topic-specific resources for both practitioners and patients to access for free.
Interestingly, many primary care and specialists expressed interest in nonpharmacological methods for treating pain, but 80% reported their patients were unwilling to try out the alternative therapies. While this may be somewhat attributable to public misconception over the perceived efficacy of nonpharmacological methods to treat pain, Dr. Harris suggested the issue could have more to do with cost, as some patients simply may not be able to get insurance coverage for those therapies.
“In my remarks to the national governors association [NGA], I mentioned some of my colleagues were saying that they have wanted to prescribe biofeedback, or they may have wanted to prescribe more physical therapy and perhaps did that, but the insurer only paid for two visits or none at all…So I think the better issue we want to look at is getting access to those nonpharmacological therapies that are proven to work,” she said.
Access to Naloxone
Physicians also appear to be in wide agreement about furthering access to naloxone, an effective opioid antagonist proven to help combat the deadly effects of opioid overdose. More than 80% of the surveyed physicians said naloxone should be made available to patients via a standing order or a collaborative practice agreement with the pharmacist.
Such policies circumvent the need for physicians to write a second prescription for naloxone, a model some states like California and Pennsylvania already have adopted in some way.1
“We make it clear that is one of the Task Force’s recommendations that a physician should prescribe naloxone when a patient is at high risk for overdose,” Dr. Harris said. The Task Force also has advocated to federal agencies to increase budget allocations to increase access to naloxone through state-based initiatives.
President Obama’s Administration’s 2016 fiscal budget included 12 million dollars in federal grants to 10 states to facilitate the purchase of naloxone.
The AMA is not the only organization taking initiative with the opioid abuse epidemic. The Centers for Disease Control and Prevention (CDC) recently announced work to compose a professional guideline for safe prescribing of opioids,2 which cover a number of important topics, including information on dosing and duration of opioid treatment for acute and chronic pain conditions.
However, the CDC’s guidelines have been questioned by professional organizations, including the AMA, which have expressed concerns the CDC guidelines are not patient-centered and clinically accurate, instead relying on a limited, low-quality evidence base and the opinions of its expert panel.
“While CDC has acknowledged that the guidelines are advisory in nature and they do not intend for state legislators, professional licensing boards, hospitals, insurers, courts, or others to ‘officially’ implement or follow specific elements of the guidelines, this is not a practical or realistic expectation given the national respect that comes with a guideline issued by CDC,” wrote James L. Madara, MD, executive vice president and CEO for the AMA, in a letter to Thomas Frieden, MD, MPH, director for the CDC.