CHICAGO - The American Medical Association (AMA) approved several opioid-related policies at its Annual Meeting that are intended to put the focus of pain treatment back on patients and away from arbitrary third-party controls.
The resolutions take aim at obstacles to effective treatment that were enacted by state and federal authorities, as well as insurers, pharmacy benefit management companies (PBMs) and national pharmacy chains. The barriers include tactics such as prior authorization and step therapy - which can delay treatment - and misguided laws and other policies setting hard thresholds for prescriptions.
One report recommends developing sound treatment plans based on individual patient needs, rather than a one-size-fits-all approach of hard thresholds. Also, the AMA opposes pharmacies, PBMs and insurers using "high prescriber" lists -- without due process - to keep physicians from writing prescriptions for controlled substances and preventing patients from filling prescriptions at their pharmacy of choice.
Another report underscores recent comments from the Centers for Disease Control and Prevention (CDC) about the inappropriate use of its opioid prescribing guidelines and assertions that the guidelines have harmed patients. The report urges state legislatures, PBMs and insurers to remove barriers, including prior authorization, to non-opioid pain care. Any opioid restrictions should have exceptions for physicians to exceed the limits if physicians determine that is medically necessary.
"Physicians have a responsibility to help end the opioid epidemic, and they are taking steps: more judicious prescribing that has resulted in a dramatic decline in opioid prescriptions, enhanced education, and lobbying for policies based on clinical evidence," said AMA President Patrice A. Harris, M.D., M.A., chair of the AMA Opioid Task Force. "Physicians can't be expected to fight the epidemic with one hand tied behind their back, handicapped by policies that limit choices for patients and have no basis in science."
The new reports mirror the common-sense proposals approved recently by the U.S. Department of Health and Human Services Interagency Pain Task Force. The recommendations balanced the need to effectively manage patients' pain while also advancing policies to end the epidemic of opioid-related harm. The task force called for multidisciplinary, multimodal approaches to treating patients with acute and chronic pain; reversing harmful policies such as arbitrary limits on prescribed pain medications; providing individualized treatment that accounts for co-morbidities and severity; encouraging better health insurance coverage of affordable, evidence-based non-opioid medications and non-pharmacologic treatments for pain and eliminating obstacles to treatment such as fail-first policies; recognizing the urgent need to address stigma as a barrier to care.
In April, the CDC said that its opioid guidelines had been widely misapplied. The guidelines have been treated as hard and fast rules. Meanwhile, some patients with acute or chronic pain can benefit from taking prescription opioid analgesics at doses that may be greater than the guidelines or hard thresholds. The AMA praised the CDC for recognizing the individual nature of pain treatment.
Surgeon General Jerome Adams, M.D., attending the AMA meeting, pointed to the problems created by what he called "the misapplication" of CDC guidelines.
Finally, delegates approved a resolution urging that the funds paid to states from settlements in litigation against opioid manufacturers and distributors be used exclusively for research, education, prevention and treatment of overdoses, opioid use disorder and pain.