Ending the opioid epidemic requires multi-stakeholder commitment

A report from The President’s Commission on Combating Drug Addiction and the Opioid Crisis provides a substantive road map to help end the opioid epidemic in our country and spur an increase in treatment for substance use disorders and multidisciplinary pain care.

Nearly 150 people die every day from an opioid-related cause, and another two million are in need of treatment. These numbers are heartbreaking and unacceptable.

{mosads}The American Medical Association (AMA) is working everyday to provide the best treatment possible for our patients and remains dedicated to doing our part to reverse this epidemic.

The commission’s final report outlines several important ways to prevent future deaths and help those in need today — ranging from ensuring medication-assisted treatment (MAT) throughout the criminal justice system to expanding treatment for patients on Medicaid to removing barriers to MAT and non-opioid pain care for all those with health insurance. Those are but a few of the forward-thinking recommendations the AMA supports.

We also recognize that America’s physicians must be the leaders our country needs to end the epidemic. Our Opioid Task Force is focused on solutions that work for patients, and we have seen some initial signs of progress from our efforts.

Between 2012 and 2016, the number of opioid prescriptions decreased every year by a total of more than 43 million. That’s a 16.9 percent decrease in four years with every state experiencing a decline.

From 2014-2016, the number of health care professionals registered with their state’s prescription drug monitoring programs (PDMP) increased 180 percent to more than 1.3 million.

Additionally, more than 118,550 physicians accessed, attended or completed continuing medical education on opioid prescribing, pain management, addiction and related areas from 2015 to 2016.

While physicians have made headway to help curb prescription opioid misuse, we need to continue to ensure that we employ judicious prescribing practices, enhance our education and co-prescribe naloxone to patients at risk of overdose. We’re pleased that national opioid prescribing rates have decreased and PDMP utilization has gone up, but that’s just a starting point.

As the commission recommended, all payers, insurers and regulators need to take action and remove prior authorization for MAT and confront any and all other barriers patients face. It’s encouraging that multiple health insurers have already moved in this direction. There are now 40,627 physicians — a 27 percent increase in the past 12 months — certified to provide office-based medication-assisted treatment for opioid use disorders across all 50 states.

We remain concerned, however, by a recent AMA survey that found 90 percent of physicians reported that prior authorizations for a wide variety of care. This delayed access to necessary care and nearly 60 percent reported that patient care was delayed by at least a day because of these manual, time-consuming processes. Delays in care continue to mean the difference between life and death. This is red tape at its worst.

We also need to protect patients with pain. We want to ensure the most effective treatment possible for pain, but physicians and patients tell us that they often cannot afford non-opioid alternatives or access multidisciplinary approaches because insurance companies won’t cover these medications or treatments. We are pleased that the nation’s attorneys general are looking into this further.

We are confident that progress in areas such as PDMP use, education, and naloxone access will continue. More than 10,000 physicians became certified to treat patients with buprenorphine in the last year alone. These steps will help but, alone, they will not be enough.

We all must work together to solve this epidemic. The AMA is ready to work with payers, insurers, patients and all other stakeholders to remove barriers to care, and we hope the commission’s report encourages all stakeholders to take the necessary steps to turn the tide in this epidemic — our country depends on it.

Dr. Patrice Harris is a past board chair of the American Medical Association and current chair of the AMA Opioid Task Force.