AMA letter on opioids leaves out recommendations from Senate’s no. 2 Democrat

In an open letter to physicians, AMA President Steven Stack, MD, asked medical professionals to “play a lead role” in reversing the rise in opioid addiction, but didn’t endorse new standards advocated by U.S. Sen. Dick Durbin, D-Ill.

Stack said pain management policies “well-intended but now known to be flawed” have contributed to the increase in abuse of opioid prescription pain relievers, and along with it, a rise in heroin-related deaths.

“As a profession that places patient well-being as our highest priority, we must accept responsibility to re-examine prescribing practices,” Stack wrote. “We must begin by preventing our patients from becoming addicted to opioids in the first place.”

To accomplish that goal, Stack asked physicians to take the following steps immediately:

• Avoid prescribing opioids for new patients with chronic pain unrelated to cancer, unless expected benefits are anticipated to outweigh the risks. Non-pharmacologic therapy and non-opioid pharmacologic therapy are preferred;
• Limit the amount and length of opioid prescriptions for post-operative care and patients with acute injuries, and don’t base prescriptions on what’s convenient for patient or physician;
• Register and use state Prescription Drug Monitoring Programs (PDMPs);
• Work on reducing opioid exposure to patients who are already on chronic opioid therapy when risks exceed benefits;
• Identify and help opioid use disorder patients in obtaining evidence-based treatment;
• Co-prescribe naloxone to patients at risk for overdose.

Stack doesn’t include steps recommended in a letter written to him by Durbin, which asked the AMA to endorse mandatory continuing education programs for prescribers and opioids, and a firm requirement to check PDMPs before writing an opioid prescription. Durbin told HealthExec he may opt for a legislative solution if medical associations like AMA don’t recommend significant changes to prescribing practices.

“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,” Durbin said.

Stack’s suggestions also leave out firm limits on the length of opioid prescriptions, unlike guidelines released by the CDC in March.