Confronting and mitigating the opioid abuse epidemic requires many different groups to work together, including physicians, pharmacists, health insurers and policymakers.
The American Medical Association outlined suggestions for how each of these groups can work to save lives from opioid addiction.
Physicians. "Physicians must play a key role all along the continuum, from prevention to intervention and referral to treatment," Patrice A. Harris, MD, a psychiatrist and chair of the AMA Board of Trustees, said at the 2017 AMA State Legislative Strategy Conference in Amelia, Fla. "And, above all, we must address substance-use disorders as brain disorders, as true medical diseases and not a social and moral failing."
Physicians must do a better job of talking with patients about the risks associated with opioid use, as well as guidelines for safe storage and disposal and nonopioid pain management, according to Dr. Harris. "We are encouraging physicians to avoid prescribing opioids to new patients with chronic, noncancer pain," she said, according to the report. "Unless the benefits are expected to outweigh the risks and opioids are clinically indicated, we recommend following the CDC guidelines of start low, go slow."
The AMA is also calling for improved access to naloxone and treatment and for the elimination of the stigma associated with substance abuse disorders.
Policymakers. Regulations have a direct effect on the rate of prescriptions for opioid painkillers. According to the AMA, the number of prescriptions filled for hydrocodone dropped by almost 10,000 per quarter in just two years across the U.S. when the narcotic was reclassified as a Schedule II drug from a Schedule III drug.
The introduction of naloxone access laws has also expanded access to the life-saving antidote to many people who would have otherwise died of opioid overdoses. More than 45 states now have naloxone access laws in place, according to the report.
Payers and pharmacies. Health insurers together with pharmacies also have the power to impose regulations on filling opioid prescriptions, according to the report. In 2011, Blue Cross Blue Shield of Massachusetts analyzed their data and identified opportunities to address the epidemic. They devised a multifaceted approach that included prior authorization for short-acting opioids after three, seven-day refills within 60 days of the original prescription. New starts of long-acting opioids required prior approval and the blocking of opioids from mail orders, according to the report. The approach reduced the rate of monthly opioid prescriptions by 15 percent overall and decreased the number of patients using prescription opioids by about 9 percent, or 14,000 fewer opioid prescriptions per month, according to the report.