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AMA Survey Finds Doctors Widely Support Prescription Drug Monitoring Programs

February 23, 2016
As policy makers take aggressive action to combat opioid-related overdoses and deaths, a large majority of practitioners appear to be in favor of Prescription Drug Monitoring Programs (PDMPs), as well as bettering access to training.

Last year, nearly 30,000 people died from prescription opioid and heroin-related events. Government agencies and professional organizations alike are adopting aggressive policies to proactively stem the tide of opioid-related mortality rates.

Just this month, the US Food and Drug Administration (FDA) announced a comprehensive action plan to reassess the way it evaluates opioid products. The Centers for Disease Control and Prevention (CDC) is devising its own prescription guidelines for treating chronic pain in adult patients. Even President Obama’s Administration buttressed its 2016 budget with a 48 million dollar stipend to improve state-level prescription drug overdose prevention.

And now, the American Medical Association (AMA) is forming its own task force to try and proactively stop opioid abuse. One of the AMA’s chief goals—getting Prescription Drug Monitoring Programs (PDMPs) more widely utilized by practitioners—appears to be a popular position with doctors, but there could be many ways to improve upon the PDMPs currently available. PDMPs currently are offered in 49 states (also in DC and the US territory of Guam). Missouri is the only state that does not have a active PDMP program. The CDC released their first report on the program in 2015.

In a recent AMA survey of 2,130 practicing US physicians, the vast majority (87%) agreed that PDMPs can be useful for getting information about a patient’s prescription history. However, surveyed physicians also wanted to enhance PDMPs by improving the integration with electronic health records. Other key features, such as a real-time data capabilities, were recommended, as well.

PDMPs: A Necessary Tool

PDMPs can be very useful to practitioners as a clinical tool to guide the decision-making process in handling opioid prescriptions. Well-funded PDMPs with real-time data capabilities immediately can enable the practitioner to:

  • Access patient prescription history for opioids and other controlled substances
  • See whether a patient accessed opioids from other providers and dispensers
  • Create and receive alerts for prescription threshold dosages and quantities
  • Refer patient to additional treatment for persistent pain or substance abuse disorder
  • Prescribe naloxone when clinically indicated

PDMPs are regarded for their usefulness in spotting drug diversion and preventing prescription drug abuse1 and generally appear to be well-approved by the majority of clinicians. A survey of Floridian physicians published back in 2014 similarly found the vast majority of doctors to be in favor of using PDMPs.2

However, many physicians still may opt to not utilize a PDMP if they run into a barrier to PDMP use, such as having fears over privacy and data security, running into undue pressure to detect misuse, experiencing confusion over distinguishing addiction and pseudo-addiction, or even encountering legal retribution from patients.3

For physicians that do utilize the PDMPs, the way they access and respond to PDMP data can vary greatly.4 According to AMA President Steven J. Stack, MD, the key is getting physicians educated about how to responsibly prescribe opioid medications to patients and how PDMP registration is a vital first step.

“If a physician is considering prescribing an opioid—whether for acute or chronic pain—we strongly encourage physicians to ensure that they are current in their knowledge and training as to when an opioid is appropriate and when it is not,” Dr. Stack stated in an AMA press release.

“This new survey helps underscore that medical societies must be leaders in providing the best resources possible to our colleagues in every state and for every specialty, both for appropriate opioid prescribing and in urging physicians to register for and use PDMPs.”

The Need for Continuing Medical Training

As part of the AMA’s five-tier action plan to combat the opioid abuse epidemic, Dr. Stack also stressed the need for enhancing education for doctors and doctors in-training to have more practical knowledge about opioid prescribing topics. A sizeable majority of respondents to the AMA survey reported taking continuing medical education (CME) about opioid prescribing (68%) and pain management with opioid alternatives (55%).

Unfortunately, the survey also found that 1 out 4 physicians in the survey could not access CME, either because it was not available for their specialty or simply did not address their clinical needs. Also, a meager 15% of physicians reported receiving any kind of education about medication-assisted treatment (MAT).

MAT is an essential tool for practitioners treating patients for opioid addiction detoxification or maintenance therapy. It typically involves the prescription of FDA-approved medications like buprenorphine, which requires an 8 hour training course to be able to prescribe and dispense the drug. A chief aim of the AMA task force is to promote doctors to pursue waiver-qualifying MAT training, which is now offered by numerous medical organizations in different formats. 

The AMA survey also found widespread support for increasing access to naloxone, where over 80% of the survey physicians said patients should receive a naloxone standing order or be granted a collaborative practice agreement with their pharmacist. This is a hopeful consensus, especially given that naloxone is underprescribed in the clinical setting.

“The next step to help increase access to naloxone is for physicians to co-prescribe this life-saving medication to patients at risk of overdose,” Dr. Stack said.

To this aim, the new White House fiscal budget appropriated 12 million dollars in federal grants to states to purchase the opioid antagonist. Also, the AMA Task Force has created its own recommendations to inform practitioners when to consider co-prescribing naloxone to patients at risk of opioid overdose.

“Just as we would co-prescribe an epi-pen to a person at risk for a life-threatening allergic reaction, we should co-prescribe naloxone to a patient at risk for overdose.”

Community Pharmacists Weigh In

The National Community Pharmacists Association (NCPA) endorsed a range of solutions to the prescription-abuse epidemic and asked lawmakers to revise an overly restrictive “lock-in pharmacy” proposal limiting Medicare beneficiary access, in comments submitted to the Senate Finance Committee, which held a hearing on February 23, 2016 entitled, “Examining the Opioid Epidemic: Challenges and Opportunities.”5

“NCPA strongly believes that there are a number of potential strategies that can be utilized such as increased access to naloxone and enhanced prescription drug monitoring programs to address the problem,” NCPA said in its comments.

To help reduce prescription drug abuse, NCPA supports expanded access to naloxone; enhanced prescription drug monitoring programs; increased prescriber education; and more appropriate use of Risk Evaluation and Mitigation Strategies (REMS).

Medicare has recently achieved significant progress tackling prescription drug abuse, NCPA noted. Agency officials just announced a 26% decrease from 2011 to 2014 of Medicare Part D beneficiaries identified as potential opioid over utilizers. This represents a 39% decrease in the share of beneficiaries using opioids who are identified as potential opioid over utilizers.

Proposed legislation (S. 1913) to establish a Medicare “lock-in pharmacy” system limiting patient access to physicians and community pharmacies “would need a number of key edits to ensure that it would be a coordinated and even-handed program,” NCPA said. Specifically, Medicare officials should administer the effort, rather than prescription drug plan sponsors, which may have a vested financial interest in steering beneficiaries to a particular pharmacy. By contrast, in virtually all of the 46 state Medicaid “lock-in” programs, it is the patient who determines which prescriber and pharmacy to use.

The AMA survey was conducted by TNS Global Research, a research agency operated under the Kantar Group Company. The survey was conducted from November 13, 2015, to November 23, 2015, and included physicians from all practice settings and regions in the US, qualified as working a minimum of 20 hours per week in patient care , having a DEA license for prescribing Schedule II controlled substances, and having prescribed opioids on weekly or more frequent basis. More information about the AMA’s Task Force action plan can be found hereFor more information on waiver-qualifying MAT training, click here.

Last updated on: March 5, 2019
Continue Reading:
AAPM Raise Concerns Over CDC Opioid Guidelines

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