AMA Calls for Physician Freedom in Opioid Prescribing

AMA Calls for Physician Freedom in Opioid Prescribing

Says CDC opioid guidelines are being misapplied

The American Medical Association says physicians need to be set free from the "inappropriate use" of opioid prescribing guidelines issued by the Centers for Disease Control 2½ years ago.

Since the guidelines were issued, countless thousands of patients have needlessly suffered because of widespread "misapplication" of the guidelines not only by physicians, but also by insurers, pharmacists, law enforcement agencies, federal regulators and state governments, said the AMA's House of Delegates at a recent interim meeting.

Although the CDC intended their guidelines to be voluntary, and only for the use of primary care physicians treating non-cancer pain, thousands of pain patients are being forced to taper down to lower opioid doses and many are even being cut off entirely and abandoned by their physicians.

Pharmacists and insurers have particularly interfered in the process, overriding medical decisions by attending physicians, refusing to fill or cover prescriptions that seem to exceed CDC guidelines. Such actions have been widely publicized and condemned by patient groups and physicians specializing pain. Yet they have continued "while the CDC did nothing to correct the false portrayal of its guideline by insurance companies and pharmacies such as CVS," said an article in Pain News Network. "The genie may be out of the bottle, but the AMA is now trying put it back in."

Resolutions favor physicians

The AMA delegates resolved that medical decisions belong firmly and only in the realm of the physician, especially the CDC guideline specifying a maximum recommended dose of 90mg MME (morphine equivalent units). The resolutions included:

RESOLVED that our AMA advocate that no entity should use MME thresholds as anything more than guidance, and physicians should not be subject to professional discipline, loss of board certification, loss of clinical privileges, criminal prosecution, civil liability, or other penalties or practice limitations solely for prescribing opioids at a quantitative level above the MME thresholds found in the CDC Guidelines for Prescribing Opioids.
RESOLVED that our AMA advocate against the misapplication of the CDC Guidelines for Prescribing Opioids by pharmacists, health insurers, pharmacy benefit managers, legislatures, and governmental and private regulatory bodies in ways that prevent or limit access to opioid analgesia.
RESOLVED that our AMA affirms that some patients with acute or chronic pain can benefit from taking opioids at greater dosages than recommended by the CDC Guidelines for Prescribing Opioids for chronic pain and that such care may be medically necessary and appropriate.
"Great to see the AMA is finally stepping up to help bring common sense to the ill-conceived and frankly very harmful CDC guideline," said Lynn Webster, MD, past president of the American Academy of Pain Medicine. "Unfortunately too many people have already been a victim of CDC's misguided attempt to address the opioid problem."

Some thoughts on MME

Bob Wailes, MD, of Rancho Santa Fe, California, a delegate for the American Academy of Pain Medicine, said:

"This is a recognition that there are many patients we deal with daily who are outside the norms proffered by the CDC guidelines. The gist of this proposal is that the CDC guidelines have gone way too far and have been used as strict legislative and pharmacy benefit limitations. We need to recognize by policy that there are patients who fall outside the guidelines."

Meanwhile, a few delegates were less enthusiastic about adopting the AMA's resolution for relaxed guidance on MME dosages, recommending that it be referred for more consideration.

According to a report in MedPage Today, Scott Pasichow, MD, of Warwick, Rhode Island, a delegate for the Massachusetts Medical Society, said:

"MMEs are part of Rhode Island state law right now, so there are places where a practice like this is enacted. I would just want more information on the effects of that being positive or negative on our patients as well as us as providers, before we come to the decision that we oppose this as anything more than guidance."

And Arlene Seid, MD, a delegate for the American Association of Public Health Physicians, agreed but for different reasons.

"I work for a regulatory agency and the issue is, sometimes guidances are used to take in drug dealers, especially those of us who do not adhere to good practice," Seid said. "I ultimately would be supportive of this [provision] properly crafted, but [for now] I would be in favor of referral."

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