Prescription drug abuse is a serious public health problem that has reached crisis levels across the United States. The governors of five New England states met earlier this week to discuss how to combat prescription drug abuse and diversion. The American Medical Association hopes they will focus on a five-pronged comprehensive, public health approach that emphasizes treatment and prevention.
First, the AMA strongly urges continued balance and state flexibility to guide policy and effectively curb prescription drug abuse, overuse, misuse and death. Pain is the most common medical complaint and can be difficult to effectively diagnose, treat and manage, especially in patients suffering from chronic pain, which is often associated with other medical and psychological needs. Physicians work extremely hard to balance their ethical obligation to treat pain against the need to recognize signs of abuse and diversion. Many key policymaking organizations, including the National Governors Association, have similarly called for states to endorse that balance rather than seeking one-size-fits-all solutions.
Second, the AMA urges that state licensing boards, public health agencies, state medical and pharmacy associations, and other stakeholders work together toward solutions that will reduce prescription drug abuse, overdose and death — including community based prevention as well as increased access to treatment for substance use disorders. Unfortunately, access to prevention and treatment services continues to be lacking as prescription drug abuse, unintentional overdose and death rates have increased substantially over the last decade. According to 2011 data analyzed by the Substance Abuse and Mental Health Services Administration, 19.3 million people needed treatment for drug or alcohol abuse “but did not receive treatment at a specialty facility in the past year.”
Third, the governors should discuss how to incorporate prescription drug monitoring programs into their state strategies, including support for the use of of these programs that can provide reliable, real-time data at the point of care and are interoperable with other states, state agencies and health care professionals. Most states have struggled to fully fund or modernize prescription drug monitoring programs to make them as useful as possible to physicians and pharmacists.
Fourth, as states seek to balance treatment and prevention with law enforcement efforts to shutter illegal pill mills, the AMA calls the governors’ attention to the fact that substance abuse and addiction demands medical treatment. Those who suffer from a substance abuse disorder have a medical disease that is treatable. Accordingly, states should work to support a full range of clinical treatment services and have policies in place that encourage treatment and prevention. More than 20 states — including Massachusetts, Vermont, Connecticut, Rhode Island, and New Hampshire — now support increased access to naloxone to help prevent death from opioid overdose. Increasing access to naloxone is excellent public policy which has already saved tens of thousands of lives, but there is more that can be done.
Furthermore, as law enforcement seeks increased access to prescription drug monitoring programs, states must adopt appropriate patient privacy and confidentiality protections. Rather than use the programs solely as a law enforcement tool, it is important to note that they contain a wealth of data that can be potentially used to evaluate outcomes and conduct focused research. The data may be useful to target areas in the state where increased prevention and treatment services may be needed as well as identify opportunities for additional, community-based services to help educate people about abuse and diversion.
Finally, we urge the governors to proceed with extreme caution when it comes to mandates. In states that have mandated prescription drug monitoring programs use and continuing medical education, for example, there has been no correlation with reduced rates of prescription drug abuse, diversion or death. Anecdotally, we note that when states seek to enact overly restrictive mandates, there has been the obvious effect of reducing the supply of opioids, but that has led to two troubling consequences: patients who suffer needlessly because they lose access to the medication they need and surges in heroin use. The latter is particularly evident throughout the New England states. The AMA encourages further discussions about how enhanced education, increased use of drug courts and removing unwanted and unused medications from communities as treatment and prevention strategies can be much more effective than one-size-fits-all mandates. The AMA cautions that efforts to reduce diversion of opioid analgesics for nonmedical use are targeted so that they do not prevent patients from getting the medication and treatment they need.
One final note for the governors in New England and across the nation is this: As you work to develop policies and initiatives to reduce prescription drug abuse and save lives, the AMA is ready to work with you. This public health crisis demands our collective efforts and expertise.Dr. Robert M. Wah is president of the American Medical Association.