AMA president issues opioid epidemic guidance US physicians



The president of the American Medical Association—Steven J Stack—has issued an open letter to US physicians about the country’s opioid epidemic.

Entitled, “Confronting a crisis: An open letter to America’s physicians on the opioid epidemic”, encourages physicians to confront widespread abuse of opioids “that, far too often, has started from a prescription pad.” Physicians, he explains, “must play a lead role in reversing the opioid epidemic.”

Stack claims that public policies, “well-intended but now known to be flawed”, have encouraged aggressive treatment of pain by opioids, “for the comfort of our patients.” Almost two million Americans, he claims, struggle with opioid abuse issues—a problem that cuts across economics and demographics. Deaths from opioid use disorders number in the tens of thousands, Stack explains, with more individuals dying as a result of a “tragic resurgence in the use of heroin.”

Advising prescribing physicians, Stack asserts that it is the responsibility of doctors to review their prescribing practices. “We must begin by preventing our patients from becoming addicted to opioids in the first place,” he writes. Encouraging collaboration with health insurance companies—both private and federal—he stresses a need to improve access to “multidisciplinary treatment programmes” for patients in pain, and “expand access for medication-assisted treatment for those with opioid use disorders.”

As healthcare providers, Stack emphasises the need to act with “compassion and the attention to the needs of our patients”. He contends that physicians must be aware of public policies which “assert unreasonable expectations of pain control”, and prioritise overall patient wellbeing over public policies which offer guidance in conflict with this.

Stack—also a practicing emergency physician—offers the following guidelines for all physicians:

  • Opt for non-pharmacologic and non-opioid pharmacologic therapy for new patients with chronic non-cancer pain. Opioid therapy should only be used in cases where the expected benefits outweigh the substantial risks.
  • Opioid prescription for postoperative care and the treatment of pain for acutely-injured patients should be limited to the lowest effective dose for the shortest amount of time. Opioids should only be prescribed in those cases of very severe pain, and not “for the possible convenience of prescriber or patient.” Stack asserts the importance of physician’s judgement and discretion in such cases.
  • State prescription drug monitoring programmes should be actively used to assist physicians in caring for patients who may be prescribed controlled substances.
  • Physicians should actively work to reduce stigma associated with opioid use disorders, “to enable effective and compassionate care.”
  • For those patients already using chronic opioid therapy—when the risks of the therapy exceed the benefits—physicians should “work compassionately to reduce opioid exposure.”
  • Improve access to evidence-based treatment by the identification and assistance of patients with opioid use disorders.
  • Naloxone should be co-prescribed for those patients who are at risk of opioid overdose.

In conclusion, Stack asserts that physicians “are on the front lines of an opioid epidemic that is crippling communities across the country”. Physicians must “accept and embrace our professional responsibility to treat our patients’ pain without worsening the current crisis,” he asserts, explaining the duty of physicians to end the opioid epidemic in the USA is both an individual and collective responsibility.