1. The AMA: Reducing Opioid Abuse in America Patrice A. Harris, MD, MA Board Chair American Medical Association September 2016

2. Opioid abuse is the biggest public health threat in the U.S. since the AIDS epidemic 2

3. © 2016 American Medical Association. All rights reserved. Drug Poisoning Deaths Involving Opioid Analgesics and Heroin: United States, 1999–2014 Sources: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Unintentional Injury PreventionCenters for Disease Control and PreventionNational Center for Injury Prevention and Control

4. © 2016 American Medical Association. All rights reserved. AMA Task Force to Reduce Opioid Abuse 4 www.ama-assn.org/go/endopioidabuse

5. © 2016 American Medical Association. All rights reserved. AMA Task Force members 5 American Academy of Addiction Psychiatry American Academy of Family Physicians American Academy of Hospice and Palliative Medicine American Academy of Neurology American Academy of Orthopedic Surgeons American Academy of Pain Medicine American Academy of Pediatrics American Academy of Physical Medicine and Rehabilitation American Association of Neurological Surgeons and Congress of Neurological Surgeons American College of Emergency Physicians American College of Occupational and Environmental Medicine American College of Physicians American College of Rheumatology American Congress of Obstetricians and Gynecologists American Dental Association American Medical Association American Osteopathic Association American Psychiatric Association American Society of Addiction Medicine American Society of Anesthesiologists State medical societies of Arkansas*, California *, Massachusetts, New York, New Mexico, Ohio, Oregon*, and Utah*

6. © 2016 American Medical Association. All rights reserved. AMA Task Force objectives Increasing physician registration for and use of PDMPs Enhancing education on safe, effective and evidence-based prescribing 1.Increase physician registration for and use of PDMPs 2.Enhance education on safe, effective and evidence- based prescribing 3.Reduce the stigma of pain and promote comprehensive assessment and treatment 4.Reduce the stigma of substance abuse use disorder and enhance access to treatment 5.Expand access to Naloxone in the community and through co-prescribing 5

7. © 2016 American Medical Association. All rights reserved. 7

8. Increase registration and use of PDMPs Quickly and accurately access your patient's prescription history Support delegate(s) in your practice to access the PDMP Interstate interoperability Create alerts for your patients Contain referral information for co-occurring mental health or substance use disorders 8

9. © 2016 American Medical Association. All rights reserved. Physicians say that PDMPs can help provide important information about a patient’s prescription history 9 Perceptions of state PDMPs in helping physicians to … Be fully informed about your patients’ prescription history Identify when patients receive multiple prescriptions Agree 87% Agree 87%

10. © 2016 American Medical Association. All rights reserved. Ensure safe, evidence-based prescribing American Academy of Family Physicians American Academy of Hospice and Palliative Medicine American Academy of Pain Medicine American Academy of Physical Medicine and Rehabilitation American College of Emergency Physicians The American College of Physicians American Congress of Obstetricians and Gynecologists American Dental Association American Society of Anesthesiologists American Society of Addiction Medicine American Osteopathic Association American Society of Interventional Pain Physicians 10

11. © 2016 American Medical Association. All rights reserved. TotalPrimary careSpecialists (2130)(1219)(911) Safe opioid prescribing69%68% Pain management with opioid alternatives54%56% Treatment and prevention of substance use disorder45%35% Prevention of diversion30%22% PDMPs17% Naloxone16%17% Medication assisted treatment14%15% Other5% 7 in 10 physicians took education on safe opioid prescribing, and more than half on pain management with alternatives. 11 Education taken by physicians

12. © 2016 American Medical Association. All rights reserved. Support comprehensive pain care; reduce the stigma of pain 12

13. © 2016 American Medical Association. All rights reserved. Reduce the stigma of substance use disorder; increase access to treatment 1.Stigma – misunderstanding of the disease 2.Capacity – lack of trained and willing providers 3.Access – treatment limits imposed by policymakers & insurers “Over the last decade, the vast majority ― about 8 in 10 ― of all individuals with an opioid use problem were not receiving any treatment at a given point in time, and rates of treatment did not improve over the decade despite a dramatic increase in deaths related to prescription drugs.” - Brendan Saloner, PhD Saloner B and Karthikeyan S. Changes in Substance Abuse Treatment Use Among Individuals With Opioid Use Disorders in the United States, 2004-2013. JAMA. 2015; 314(14):1515-1517.

14. © 2016 American Medical Association. All rights reserved. Increase access to naloxone; co-prescribe naloxone; support broad Good Samaritan protections Questions for physicians to consider before co-prescribing or prescribing naloxone: Is my patient on a high opioid dose? Is my patient also on a concomitant benzodiazepine prescription? Does my patient have a history of substance use disorder? Does my patient have an underlying mental health condition that might make him or her more susceptible to overdose? Does my patient have a medical condition, such as a respiratory disease or other co- morbidities, which might make him or her susceptible to opioid toxicity, respiratory distress or overdose? Might my patient be in a position to aid someone who is at risk of opioid overdose? 14

15. © 2016 American Medical Association. All rights reserved. Signs of progress … Opioid prescribing decreased in every state in U.S. in 2015 – 10.6% overall Steady growth in physicians certified to treat substance use disorders – 81% in four years More doctors are using PDMPs before prescribing – 40% increase between 2014 and 2015 14

16. © 2016 American Medical Association. All rights reserved. More signs of progress … Naloxone access soared between 2013 and 2015 – 1,100% More than 45 states now have naloxone access laws Drug-related deaths have decreased in 15 states and counting … 16

17. © 2016 American Medical Association. All rights reserved. 17 RegistrationQueries 60.7M 84.9M 40% Increase National Growth in PDMP Use

18. © 2016 American Medical Association. All rights reserved. State Spotlights … 18

19. © 2016 American Medical Association. All rights reserved. State Spotlight … Pennsylvania 19 First in the U.S. to issue a statewide prescription for Naloxone – allowing anyone to purchase it at a drug store or pharmacy Move credited with saving more than 1,000 lives to date Source: Pennsylvania Medical Society and the state’s Department of Health

20. © 2016 American Medical Association. All rights reserved. State Spotlight … Rhode Island One of two states working with AMA on a opioids tool kit for physicians (Alabama) Toolkit launches online and in print in September Includes state and county specific data, resources and recommendations to assist physicians 20

21. “To promote the art and science of medicine and the betterment of public health” 20

22. © 2016 American Medical Association. All rights reserved.