- Clinicians are increasing patient access to medications commonly used to halt an opioid overdose and to treat substance abuse disorder, tackling the opioid crisis on the frontlines, according to the American Medical Association Opioid Task Force 2018 progress report.
More providers than ever before are prescribing naloxone, the drug used to reverse the effects of an opioid overdose. The rate of naloxone prescriptions more than doubled between 2016 and 2017, going from about 3,500 prescriptions to 8,000 prescriptions for the drug.
Between January and April of 2018 alone, prescriptions for naloxone reached over 11,600 prescriptions.
Providers are prescribing naloxone as a part of the Surgeon General’s and AMA’s recommendations to improve patient access to the medication.
“Research shows that when naloxone and overdose education are available to community members, overdose deaths decrease in those communities,” the Surgeon General said in an advisory. “Therefore, increasing the availability and targeted distribution of naloxone is a critical component of our efforts to reduce opioid-related overdose deaths and, when combined with the availability of effective treatment, to ending the opioid epidemic.”
Providers are also increasing patient access to medication assisted treatment (MAT) for opioid misuse. MAT uses evidence-based medications to help treat patients suffering from substance abuse disorder by relieving the effects of withdrawal and reducing the psychological needs to use a substance. MAT for opioid use includes drugs such as buprenorphine, methadone, and extended release naltrexone.
The number of providers certified to offer buprenorphine treatments increased by 42 percent, or 15,000 providers, in the past 12 months, the AMA report showed. At this time, over 50,000 providers are able to deliver this treatment to patients.
AMA noted that bureaucratic measures such as prior authorization for MAT now serve as a barrier keeping more patients from accessing these medicated treatments.
At the same time, providers are decreasing the number of opioids they prescribe to patients. From 2013 to 2017, the number of prescribed opioids decreased by 55 million, or 22 percent. Between 2016 and 2017 alone, opioid prescriptions fell by 9 percent, AMA reported.
Providers are taking other actions to limit unnecessary patient access to the drug by enrolling in prescription drug monitoring programs (PDMPs), or national databases that help providers flag patients who might not be a good fit for opioid treatment.
Over 1.5 million providers are enrolled in a PDMP. Between 2016 and 2017, that number increased by 241,000 providers.
Improving patient access to life-saving treatments, combined with more judicious prescribing of opioids, are working together to quell the crisis, according to Patrice A. Harris, MD, MA, of the AMA Opioid Task Force.
“The largest decrease in opioid prescriptions in 25 years reflects the fact that physicians and other health care professionals are increasingly judicious when prescribing opioids,” Harris said. “Unfortunately, deaths related to heroin and illicit fentanyl, and to prescription opioids, continue to rise. These statistics prove that decreasing prescriptions alone will not end the epidemic. We need well-designed initiatives that bring together public and private insurers, policymakers, public health infrastructure, and communities with the shared goal to improve access and coverage for comprehensive pain management and treatment for substance use disorders.”
Other healthcare professionals have taken a similar stance. Simply cutting all patient access to opioid treatment is not the best way to combat the opioid crisis because it does not take into account the human factors that can lead to substance abuse disorder. Provider and patient education will be essential to make sure patients fully understand their medications and the potential side effects.
Additionally, seriously limiting patient access to opioid treatments undermines patients who genuinely need the prescription.
In a July 9 statement, FDA Commissioner Scott Gottlieb explained that strict opioid prescribing laws can cause more harm than good to patients who suffer from chronic pain or metastatic cancer pain who truly need access to a long-term opioid treatment.
“Tragically, we know that for some patients, loss of quality of life due to crushing pain has resulted in increased thoughts of or actual suicide,” Gottlieb explained. “This is unacceptable. Reflecting this, even as we seek to curb overprescribing of opioids, we also must make sure that patients with a true medical need for these drugs can access these therapies.”
Alongside AMA and other industry stakeholders, FDA agrees that judicious opioid prescribing habits are essential to combatting the opioid crisis. However, it is equally important to facilitate patient access to other tools that will help patients understand their opioids and recover should they develop a substance abuse disorder.