Public Health Group Calls for Action to Curb Opioid Abuse

Kathleen Louden

November 20, 2015

CHICAGO — Reducing the abuse of prescription painkillers in the United States will require multiple legislative and educational strategies at the local, state, and national levels, according to a new policy statement from the American Public Health Association (APHA).

"The APHA's existing policy focuses predominantly on naloxone distribution programs to reverse the effects of opioid overdose," Cynthia Stone, DrPH, RN, a member of the APHA Nursing Section, which sponsored the statement, told Medscape Medical News.

The APHA is the latest healthcare organization to call for greater action to decrease what it calls an epidemic of unintentional overdose deaths due to prescription painkillers, especially opioid analgesics.

The Prevention and Intervention Strategies to Decrease Misuse of Prescription Pain Medications policy statement was announced here at the APHA 2015 Annual Meeting after it was adopted by the association's Governing Council. It will be published on the APHA website early next year.

The statement encourages wider access to naloxone for first responders, family members, and friends of people who may be misusing opioids, and proposes more wide-ranging initiatives to prevent the misuse and abuse of prescription painkillers.

Educating Practitioners, Patients, and the Public

The policy statement suggests action steps for healthcare providers, legislators, and the public.

For practitioners, it advises the implementation of evidence-based provider training programs on mental health, substance abuse and overdose prevention, risks and benefits of high-dose opioid therapy, nonpharmacologic alternatives to pain treatment, and referral and treatment for suspected drug abuse.

It also suggests that continuing education be provided at the time of licensing renewal, that pain management be coordinated with complementary and integrative care providers, and that state-based prescription drug monitoring programs be used before and routinely after the prescription of pain medications.

And it supports the education of patients and the public about the need to take prescription pain medicine as ordered, and to not share medications, to store them in a secure location, and to properly dispose of any leftovers.

The medicine cabinets of family and friends "are a primary source for sharing and stealing opioids," Dr Stone said.

Many states recommend that providers use prescription drug monitoring programs. Dr Stone said that the statement developers would like to see these programs be a requirement. She added that providers "need to be educated on referral and treatment options" when the program identifies a concern.

Best Practices for Prescribing Pain Medication

Don't prescribe a month's worth of pills for an acute, short-term condition.

Providers also need to use best practices when prescribing pain medication. For instance, "don't prescribe a month's worth of pills for an acute, short-term condition," she explained.

"We advise that practitioners start with non-narcotic pain medications and nonpharmacologic agents, such as acupuncture and chiropractic treatment, if appropriate, before prescribing opioids," Dr Stone said.

One of the steps directed at state legislators proposes that providers be required to perform mental and physical examinations before prescribing pain medications. Another recommendation is to pass more state laws to prevent "doctor shopping," the practice of visiting multiple physicians to gain prescriptions for painkillers.

Dr Stone acknowledged, however, that doctor-shopping laws could impede access for patients who legitimately need prescription pain medicine.

The statement provides solutions to this problem. It suggests that policy initiatives focus on both the supply and demand of prescription painkillers and pay greatest attention to the populations that most frequently misuse and abuse prescription drugs.

These populations, according to the statement and the Substance Abuse and Mental Health Services Administration, include young adults, veterans, military service members, and adults 50 years and older.

Policy Needs More Specifics

"Before a provider prescribes a medication, obtaining a history and physical examination is the standard of care and is required for prescribing opioids," said Edward Michna, MD, director of the Pain Trials Center at Brigham and Women's Hospital and a director at large for the American Pain Society.

"Seeing a psychiatrist or psychologist for a formal mental health evaluation is not practical from a clinical practice standpoint, certainly not if the prescription is for an acute injury," he told Medscape Medical News.

The way to address doctor shopping is by requiring use of the state prescription drug monitoring program.

Dr Michna, who was not involved in the development of the policy statement, said he disagrees with the recommendation for more doctor-shopping laws. "I think the way to address doctor shopping is by requiring use of the state prescription drug monitoring program," he said.

Although Dr Michna said he would like to see the policy statement better define provider education, he agrees that provider education should be part of state licensing.

Dr Stone reported that the APHA plans to form an interdisciplinary group of "policy champions" to prioritize and work on some of the proposed action steps.

APHA policy statements help shape the association's stance on public health topics and serve as a resource for its staff, members, affiliates, partners, and policymakers.

Dr Stone and Dr Michna have disclosed no relevant financial relationships.

American Public Health Association (APHA) 2015 Annual Meeting. Presented November 3, 2015.


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