The American Medical Association (AMA), shortly after asking the Centers for Disease Control and Prevention (CDC) to reevaluate their opioid guidelines, has published a report from their opioid task force, detailing physician’s progress toward ending the opioid epidemic.
The report notes that the AMA taskforce’s recommendations have led to:
- A 37.1% decrease in opioid prescriptions from 244.5 million in 2014 to 153.7 million in 2019
- A 64.4% increase in the use of state prescription drug monitoring programs, which hit 739 million queries in 2019
- Hundreds of thousands of physicians accessing continuing education on substance use disorders, pain management, and more
- 85,000+ physicians and healthcare professionals certified to prescribe buprenorphine in office, an increase of nearly 50,000 since 2017
While the report celebrates these developments, it states that over 2 million Americans have untreated substance use disorders, specifically encouraging policymakers to remove barriers to evidence-based care for patients with pain and those with a substance use disorder, stating the epidemic will continue or worsen without such change.
The AMA points to research data, noting that 92% of pain medicine specialists have been required to submit prior authorization requests for non-opioid pain care, which requires physicians and staff to spend hours per day on such requests. In essence, trying to use an alternative to opioids has been met with difficulty.
Furthermore, the AMA believes that opioid policy has been driven by a reaction crisis framework; the AMA wants healthcare workers, policy makers, and other stakeholders, to develop a new, holistic model for preventing overdose, one that acknowledges patient individuality in order to provide better care. The AMA believes that various opioid guidelines that have enforced hard opioid limits may be considered one-size-fits-all strategies.
Overall, the AMA has six recommendations for embracing this new policy model:
- Remove prior authorization, step therapy and other inappropriate administrative burdens or barriers that delay or deny care for FDA-approved medications used as part of medication-assisted treatment for opioid use disorder
- Support assessment, referral and treatment for co-occurring mental health disorders as well as enforce meaningful oversight and enforcement of state and federal mental health and substance use disorder parity laws, including requiring health insurance companies to demonstrate parity compliance at the time of their rate and form filing
- Remove administrative and other barriers to comprehensive, multi-modal, multidisciplinary pain care and rehabilitation programs
- Support maternal and child health by increasing access to evidence-based treatment, preserving families, and ensuring that policies are nonpunitive
- Support increased efforts to expand sterile needle and syringe services programs as well as reforms in the civil and criminal justice system that help ensure access to high quality, evidence-based care for opioid use disorder, including medication-assisted treatment
- Implement systems to accurately track overdose and mortality trends to provide equitable public health interventions that include comprehensive, disaggregated, racial and ethnic data collection related to testing, hospitalization and mortality associated with opioids and other substances