Barriers to Care Threaten Physicians' Progress on Opioids

Marcia Frellick

June 10, 2019

CHICAGO — Physicians have made progress in reversing the opioid crisis, but regulators and policy makers must eliminate obstacles to medication-assisted treatment, according to a report from the American Medical Association (AMA).

The report, released just before the 2019 AMA Annual Meeting opened, calls for payers, pharmacy benefit managers, and pharmacy chains to end treatment restrictions "based on arbitrary thresholds."

"Physicians must continue to demonstrate leadership, but unless and until these actions occur, the progress we are making will not stop patients from dying," the report explains.

More than 25 national, state, specialty, and other healthcare associations working to help end the opioid epidemic make up the AMA opioid task force, which was formed in 2014 and is chaired by AMA President-Elect Patrice Harris, MD.

Among the specific actions the report calls for are:

  • The elimination of prior authorization and step therapy that delay or deny care used in medication-assisted treatment.

  • The enforcement of laws that require insurance parity for mental health and substance use disorders.

  • The end of barriers to comprehensive, multidisciplinary pain care, including nonopioid alternatives.

Physicians' Work Paying Off

Among the key physician-driven advances is the boom in naloxone availability. Nearly 600,000 naloxone prescriptions were dispensed in 2018 — more than triple the 136,000 dispensed in 2016, according to IQVIA research.

Physicians and other clinicians made more than 460 million queries in 2018 to the prescription drug-monitoring program, which is a 56% increase from 2017 and a 651% increase from 2014.

And opioid prescriptions in 2019 were down 33% from 2013, the report notes. Every state saw a decline.

There's no other part of medicine that's really been legislated like this.

Opioids were also the topic of other reports and resolutions as reference committee discussions began at the meeting.

Jerome Adams, MD, Surgeon General of the United States, acknowledged that overprescribing is still happening, and testified that "people are being hurt by the misapplication of the [Centers for Disease Control and Prevention] guidelines."

He pointed delegates to a report — No Shortcuts to Safer Opioid Prescribing — that addresses the misinterpretation of the 2016 CDC guidelines (N Engl J Med. Published online April 24, 2019).

"We need your help to help folks understand that these guidelines were not meant for cancer patients," for instance, he said.

A proposal in a board of trustees report (BOT 22) that advocates against hard thresholds for opioid prescribing and against "high prescriber" lists when they are used by pharmacy chains, pharmacy benefit management companies, or health insurance to "blacklist" physicians from writing prescriptions and keep patients from refilling medications, was supported by the testimony of Bob Wailes, MD, from the American Academy of Pain Medicine.

"There's no other part of medicine that's really been legislated like this," he said.

Another proposal in the BOT 22 report asks that the AMA push for state legislatures and other policymakers to lift barriers, including prior authorization, to nonopioid pain care and to allow exceptions to thresholds on opioids for postoperative care when physicians deem they are medically necessary.

David Tayloe, MD, from the AMA Council on Legislation, urged that the report be adopted. "Much damage has been done as a result of these prior authorization policies and other barriers to opioid analgesics postsurgery," he said.

In addition, resolution 204 proposes that the AMA "advocate that the relevant pharmaceutical industry organizations be held financially responsible for the health care and other economic costs related to their unethical and deceptive misbranding, marketing, and advocacy of opioids."

Harris, Adams, Wailes, and Tayloe have disclosed no relevant financial relationships.

American Medical Association (AMA) 2019 Annual Meeting.

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