Ending the nation’s opioid epidemic

requires physician leadership

Patrice A. Harris, MD, MA
Chair, AMA Opioid Task Force
April 2018
Illicit fentanyl and heroin leading causes of opioid-related mortality

© 2018 American Medical Association. All rights reserved.

© 2018 American Medical Association. All rights reserved.
© 2018 American Medical Association. All rights reserved.
© 2018 American Medical Association. All rights reserved.
 Physicians taking action:
PDMP use increasing; opioid supply decreasing
350,000,000 PDMP queries: 2014-2017 Retail filled opioid analgesics:
300,000,000
251,814,801 2013-2017
244,462,569

250,000,000
227,780,920
200,000,000
215,051,279
150,000,000

100,000,000 196,001,292

50,000,000

0
2014 2015 2016 2017 2013 2014 2015 2016 2017
Source: AMA survey of state PDMP administrators Source: Xponent, IQVIA; PayerTrak, IQVIA

© 2018 American Medical Association. All rights reserved.

6
 • 2012: Rx opioid
prescribing starts to
decline
• 2013: PDMP use begins
to increase
• 2015-2017: States
implement majority of
PDMP, opioid
prescribing restrictions

© 2018 American Medical Association. All rights reserved.

Opioid MME decreasing; significant regional variability

© 2018 American Medical Association. All rights reserved.

AMA Opioid Task Force recommendations

www.end-opioid-epidemic.org
© 2018 American Medical Association. All rights reserved.
 www.end-opioid-epidemic.org/treatment
© 2018 American Medical Association. All rights reserved.
© 2018 American Medical Association. All rights reserved.
Percent population needing but not receiving treatment for illicit drug use

Source: NSDUH, http://opioid.amfar.org/indicator/pctunmetneed

© 2018 American Medical Association. All rights reserved.

Lack of Access to Treatment: Substance Abuse Facilities Offering All Three
Forms Of Medication-Assisted Treatment, 2016

Source: Substance Abuse and Mental Health Services Administration’s National Survey of Substance Abuse Treatment
Services. https://www.healthaffairs.org/do/10.1377/hblog20180104.835958/full/
© 2018 American Medical Association. All rights reserved.
Barriers to MAT are nationwide

“Advancing Access to Addiction Medications: Implications for Opioid Addiction Treatment.” The American Society of
Addiction Medicine, 2013. https://www.asam.org/docs/default-source/advocacy/aaam_implications-for-opioid-addiction-
treatment_final.pdf?sfvrsn=cee262c2_25
We all have to work together
• Remove prior authorization and step
therapy for MAT
• Monitor and enforce network
adequacy requirements, substance
use disorder and mental health
parity laws
• Increase access to comprehensive,
multidisciplinary pain care, including
non-opioid alternatives
• Evaluate what works—change what
is not helping our patients

© 2018 American Medical Association. All rights reserved.

Which guideline/recommendation/best practice/policy is a physician
supposed to follow?

© 2018 American Medical Association. All rights reserved.

A few of the reasons why we have reason to be optimistic

© 2018 American Medical Association. All rights reserved.

 There is much more work to do
• Ensure a public health focus
• PDMPs – we must work to transform these database
tools into clinical tools
• Treatment – we must continue to urge payers to
remove barriers to care
• Overdose prevention – naloxone co-prescribing can
save lives, lead to important discussions
• Policy – with the hundreds of new laws, regulations
and other policies, we must evaluate what works and
amend what doesn’t
• Coalition building – ending the epidemic requires us all
to work together!

© 2018 American Medical Association. All rights reserved.

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