Sen. Durbin urges AMA, others to take action on opioid prescriptions

While Congress takes its first steps on legislation addressing the rise in opioid abuse, major medical associations can help by issuing new standards for physicians prescribing those drugs, according to Sen. Dick Durbin, D-Ill., the no. 2 Democrat in the Senate.

In letters sent to the American Medical Association, the American Academy of Family Physicians, the American College of Emergency Physicians and the American Dental Association, Durbin asked the groups to “take responsibility” for the role physicians and other prescribers have played in overprescribing opioids, and support evidence-based interventions and new mandatory continuing education programs for opioid prescribers.

Durbin spoke with HealthExec about what he’s heard from physicians prescribing opioids, where he feels medical associations have fallen short, and whether federal legislation on prescribing practices will be needed.

HealthExec: What do you hope the reaction will be from medical associations when they receive these letters?

Durbin: I’ve studied this issue of addiction to pain pills called opioids, as well as heroin addiction and overdose across the state of Illinois. Several things are very clear: the pharmaceutical industry across America is dramatically overproducing these pain pills.

We estimate they make about $14 billion of these pills each year, enough for every adult in America to have a one-month prescription, far beyond what’s necessary for good medical treatment, and these pills are then being prescribed by doctors and dentists to their patients in numbers that are indefensible. They are sending them home with bottles of these opioid tablets which unfortunately, in many cases, create addictions, and in other cases, just become the currency of drug dealers on the street.

So I’ve written to the major medical associations and said that the doctors and the dentists have to accept their responsibility here. They have got to be more careful to make sure those who receive these pills truly need them, and they aren’t sent out of their offices and pharmacies in amounts that lead to addiction.

HealthExec: Have you heard from doctors, even anecdotally, that what you’re asking of associations would help?

Durbin: I’ve heard from doctors in both directions. Many doctors say, "It’s not our fault, we’re trying to keep our patients happy and satisfied." That’s not a good answer. They have a responsibility beyond the happiness of the patient. They have to make certain they’re doing what’s medically necessary, number one, and do no harm to the patient. Creating an addiction to opioids is certainly a harm.

Secondly, some doctors have said that as far as they are concerned, these prescription amounts are being asked for by the pharmaceutical companies, and they’re following their instructions. I think it’s gone way out of control.

Ask somebody who’s been to a dentist or a doctor lately if they received any of these pills and how many they took home. You may only need them for two or three days. They usually give prescriptions that go on for a week or longer, and that’s where we get into trouble.

HealthExec: Do you get the sense medical professionals are turning around on this issue now, and starting to realize there’s a problem that a year or two ago they failed to recognize?

Durbin: I think, for the first time, doctors are starting to recognize that they need to be part of the solution when it comes to opioid and heroin addiction. The Centers for Disease Control just put out guidelines, and doctors should follow those carefully. They may be held legally to the standard of those guidelines. They’ve got to take this seriously.

There was an argument some made: "Let’s go to medical schools and train the incoming doctors." That’s not good enough. There are too many of these pills being prescribed now and overprescribed to people who don’t need them.

Let me add there are people who desperately need good pain management for chronic and acute pain. I want to make sure that they have the pain medication that they need, but we’ve got to stop the overprescription to people who clearly don’t need, and certainly don’t need it in the quantities that are prescribed.

HealthExec: Why not go the legislative route regarding these kinds of prescribing practices? Have those efforts gotten anywhere?

Durbin: I’m going to introduce a bill, and I hope it isn’t needed.

I’ve always said that when I put in these bills that require, for example, that doctors check the prescription monitoring agencies in each of their states to find out if this person is running from doctor to doctor to try to pick up more pain pills, I’ve got a bill that requires it, that the background check be made. I hope we don’t have to reach that point, and I hope the professions, based on this letter and other information, will take responsibility on their own. We won’t need a bill or a law at that point.