Marcia Frellick

September 15, 2017

SAN ANTONIO, Texas — People looking to place blame for the nation's opioid crisis too often point the finger at physicians, some speakers said at a reference committee for the American Academy of Family Physicians (AAFP) 2017 Congress of Delegates.

As communities across the country deal with the escalating opioid crisis, clinicians, public health officials, and the public are increasingly looking for answers, solutions, and — sometimes — where to place blame.

Several resolution clauses presented in a committee hearing Monday addressed shared responsibility and the need for education of physicians, officials, and the public on evidence-based prescribing. But the clause that caught the most attention directed the AAFP to mount a nationwide public relations effort to "dispel the myth that places blame on physicians."

Some delegates who spoke against the resolution pointed to the large cost estimated for the proposal (more than $550,000 for a 12-month campaign). Others noted that changing minds would take time. And some simply said it was not a road AAFP should take.

However, the resolution passed the committee and was referred to the AAFP board on Wednesday.

Timothy Alford, MD, a delegate from Mississippi, which sponsored the resolution, said, "I can tell you we've got good physicians in rural America, right in the wheelhouse of what we do, where this problem is very pervasive, and they're getting thrown under the bus by the press, and everybody else."

David Hoelting, MD, a delegate from Nebraska, told Medscape Medical News, "Physicians, especially family physicians and orthopedists, are receiving the most pressure for prescriptions of opiates. A lot of this started as a result of the "fifth vital sign" program started around year 2000. First there was pressure to relieve all pain, then when addiction levels soared, we got the blame. The most serious problem now is that physicians are stopping narcotics to many of the patients abruptly, forcing them to resort to illegal street drugs, and risking overdoses."

Jim Taylor, MD, an alternate delegate from Louisiana, said the issue has become a political football.

"The perception battle is one we're losing. I think a half-million dollars is a very reasonable amount to spend on a national campaign to push back against those who actually push us into this."

Other clauses in the resolution included asking that the AAFP to support appropriate and individualized pain treatment by physicians, educate family physicians in evidence-based pain management and prescribing, and educate government and law officials that a balanced approach is needed.

Clauses also promoted prescription monitoring and cognitive-behavioral therapy.

Domenic Casablanca, MD, a delegate from Connecticut, said those parts of the resolution are already being covered by current AAFP policy and launching the public relations campaign would take the academy in the wrong direction.

"Our delegation felt strongly there's nothing to be gained in terms of making us look better by the PR campaign. It's a multifactorial problem and we don't want to lower ourselves to that level," he said.

Dennis Dmitri, MD, a delegate from Massachusetts, said 2 years ago political will had turned against physicians, and physicians in the state were getting blamed for the opiate crisis.

It wasn't until physicians sat down with government officials and legislators to work cooperatively with them, rather than defensively, on the issue that the tide turned, he said. That had a positive effect on the kind of legislation that was subsequently passed.

Dr Dimitri said the Massachusetts Medical Society launched a public relations campaign, but "not one aimed at buffing the reputation of physicians." Instead it was aimed at educating the public about why there is an opioid crisis, how it could be addressed, how members of the public could be more careful about their own use of opiates, and how they could better interact with their physicians.

"That really changed the perception of physicians and the role they might play," he said, "other than simply trying to say it's not our fault."

No relevant financial relationships have been disclosed.

American Academy of Family Physicians (AAFP) 2017 Congress of Delegates. Presented September 11 and 13, 2017.

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