AMA: Physicians Cut Opioid Scripts 33%, Yet the Crisis Persists

Physicians, you’re doing your part to fight the opioid crisis.

In fact, a new report from the American Medical Association (AMA) says that to a degree, physicians are over-doing the response.

One clear implication of this AMA report is that while prescribing may or may not have been a significant trigger for the nation’s opioid crisis, the main causes of the problem are now elsewhere.

“Between 2013 and 2018, the number of opioid prescriptions decreased by more than 80 million—a 33 percent decrease nationally. Every state has seen a decrease in opioid prescriptions over the last five years. The nation saw a 12.4 percent decrease—more than 20 million fewer prescriptions—between 2017 and 2018 alone,” the AMA paper says, citing data from IQVIA of Danbury, Connecticut.

AMA Continues to Push for Evidence-Based Prescribing Guidelines

The report, from the AMA Opioid Task Force, says AMA “…continues to urge physicians to make judicious and informed prescribing decisions to reduce the risk of opioid-related harms, but acknowledges that for some patients, opioid therapy, including when prescribed at doses greater than recommended by some entities, may be medically necessary and appropriate.”

That statement reiterates what the AMA and others have said before: that the 2016 Centers for Disease Control (CDC) guideline is insufficiently flexible. The AMA report quotes a U.S. Department of Health and Human Services’ May 2019 statement, “Pain Management Best Practices Inter-Agency Task Force Report: Updates, Gaps, Inconsistencies, and Recommendations” (“Federal Task Force Issues Best Guidance Ever on Pain Management,” Orthopedics This Week, May 15, 2019), saying: “A more even-handed approach would balance addressing opioid overuse with the need to protect the patient-provider relationship by preserving access to medically necessary drug regimens and reducing the potential for unintended consequences.”

Both the CDC and the Food and Drug Administration have said they’re working on new evidence-based opioid prescribing guidelines.

Physicians Are Using PDMPs En Masse…

In a trend the AMA sees as highly positive, physician use of their state prescription drug management programs (PDMPs) to prevent patients from opioid prescriber-shopping is surging.

“Today, nearly 2 million physicians and other health care professionals are registered to use state-based PDMPs—a 290 percent increase from 2014. Physicians and other health care professionals made more than 460 million PDMP queries in 2018—a 56 percent increase from 2017 and a 651 percent increase from 2014,” the AMA said, in new data developed by the AMA in a survey of 49 state PDMP administrators.

…Except in Missouri

The AMA didn’t comment on this detail, but Missouri still doesn’t have a PDMP, and won’t start setting one up this year, thanks to a small group of recalcitrant legislators. It appeared as recently as April that Missouri would enact legislation authorizing a PDMP, after the lower house of the state legislature approved a bill, H.R. 188, on a 103-53 vote on February 19.

However, in May, the bill died for the seventh year in a row in the state Senate, when a few members prevented it from coming up for a vote. The legislature shut down for the year on May 17. The Kansas City Star summed up much of the opposition’s rationale when it reported that during February’s debate over the bill in the Missouri House, “Rep. Jered Taylor, R-Nixa, passionately denounced the bill… ‘Our job is to protect the freedoms of liberties,’” the Star reported him as saying.

AMA Praises Boost in M.D. Education, Widening Availability of Opioid Treatments

The AMA report also said:

• “Physicians and other health care professionals completed continued medical education courses, reviewed education and training resources and accessed other opioid prescribing, pain management, opioid use and substance use disorder treatment and other related areas more than 700,000 times in 2018—an increase of 150,000 from 2017,” citing an AMA survey of the nation’s medical societies.
• “More than 66,000 physicians (as well as a growing number of nurse practitioners and physician assistants) now are certified to treat patients in-office with buprenorphine—an increase of more than 28,000 from 2016,” citing statistics from the federal Substance Abuse and Mental Health Services Administration (SAMHSA).
• “Nearly 600,000 naloxone prescriptions were dispensed in 2018—almost a threefold increase from the 136,000 dispensed in 2016.”

The AMA also praised a trend among pharmacy benefit managers toward removing requirements for prior authorizations for medication-assisted treatment of opioid disorders.