Marcelo E. Bigal, MD, PhD, Chief Medical Officer, Purdue Pharma
As a physician and researcher who focused for more than two decades on patients with headaches and other forms of pain, and as the chief medical officer of a company that manufacturers prescription opioids, I am encouraged by the American Medical Association (AMA) Opioid Task Force 2018 Progress Report. The report, which highlights physicians’ progress toward reversing the nation’s opioid crisis, demonstrates marked changes in clinical practice as evidenced by a decrease in the number of opioid prescriptions and a substantial increase in the use of Prescription Drug Monitoring Programs (PDMPs).
As detailed in the AMA report, the number of opioid prescriptions decreased by 22.2 percent between 2013 and 2017.1 Physicians are to be commended for writing fewer prescriptions for opioids. While prescription opioids may help patients when other treatment options are insufficient, we are acutely aware of the health risks they can create, even when taken as directed. We believe that prescription opioids should be prescribed at the lowest effective dosage for the shortest adequate duration, and we support limiting the duration of the first opioid prescription. We support efforts to properly control pain with multi-modal therapies, such as non-pharmacologic and non-opioid therapies, and believe it is possible to avoid unnecessary exposure to opioids without neglecting the needs of patients with pain.
The AMA report highlighted another positive trend — a significant increase in PDMP usage. These electronic databases that track controlled substance prescriptions can be used to help inform physicians’ clinical and prescribing decisions. Studies suggest that PDMPs can help reduce the number of prescriptions written for opioids and that PDMP use is associated with a reduction in pain medications received for non-medical use from multiple doctors.1,2 As reported by the AMA, physicians and other health care professionals made more than 300 million PDMP queries in 2017 — a 121 percent increase from 2016 and nearly a four-fold increase from 2014.3
Purdue supports efforts to improve PDMP utility for clinicians, including the ability to access data across state lines. To aid in this effort, we provided funding to enable states to connect at no cost to the National Association of Boards of Pharmacy platform to share PDMP data with other states.
Restricting the supply of prescription opioids will ultimately limit the amount of unused opioids that could be diverted and abused but will not prevent all opioid abuse. Initiatives to address the opioid crisis should also focus on the needs of individuals living with addiction as well as those in recovery. As cited by the AMA report, physicians have continued to increase access to naloxone, an opioid reversal agent, through co-prescribing and advocating for standing orders. Naloxone prescriptions more than doubled in 2017, from approximately 3,500 to 8,000 prescriptions dispensed per week.3
I recently expressed our company’s support for policies that encourage expanding naloxone use such as greater availability for use by law enforcement and other first responders, providing appropriate civil immunity to persons aiding in a potential overdose situation (“Good Samaritan” laws), and making naloxone available without a prescription.3 Purdue has also provided funding to the National Sheriffs’ Association, enabling the association to offer naloxone kits and training free of charge to law enforcement agencies across the country.
The AMA report also highlights that physicians are helping to improve access to Medication-Assisted Treatment (MAT) for those struggling with substance use disorder. Evidence shows that combining the judicious use of medications approved by the FDA specifically for use in managing opioid addiction with counseling and behavioral therapies effectively treats opioid use disorder.4 Purdue supports affordable, culturally appropriate, convenient, and timely access to MAT.5,6
In addition to the inclusion of FDA-approved MAT on prescription drug formularies, the AMA wisely urges policymakers and insurers to remove other barriers to care for pain and substance use disorders, including: increasing oversight and enforcement of parity laws for mental health and substance use disorders to ensure patients receive the care that they need, and improving access to affordable, non-opioid pain care. We wholeheartedly support these recommendations.
At Purdue, we understand that no one solution will end the crisis. We believe that multiple, overlapping efforts will drive positive change. We commend the actions physicians are taking to address the opioid crisis. We will continue to take action, too. As a society we must continue to come together to drive meaningful solutions forward.
1Bao Y, Pan Y, Taylor A. Prescription drug monitoring programs are associated with sustained reductions in opioid prescribing by physicians. Health Affairs (Project Hope). 35(2016)1045–1051. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5336205/.
2Ali MM, Dowd W, Classen T. Prescription drug monitoring programs, nonmedical use of prescription drugs, and heroin use: evidence from the National Survey of Drug Use and Health. Addictive Behaviors. 69(2017)65–77.
3American Medical Association. American Medical Association Opioid Task Force 2018 progress report. Retrieved from: https://www.end-opioid-epidemic.org/wp-content/uploads/2018/05/AMA2018-OpioidReport-FINAL-updated.pdf. Accessed July 5, 2018.
4National Institute on Drug Abuse. Effective treatments for opioid addiction. https://www.drugabuse.gov/publications/effective-treatments-opioid-addiction/effective-treatments-opioid-addiction.
Accessed July 5, 2018.
5Lipari RN, Park-Lee E, Van Horn S. Substance Abuse and Mental Health Services Administration (SAMHSA). America’s need for and receipt of substance use treatment in 2015. The CBHSQ Report. https://www.samhsa.gov/data/sites/default/files/report_2716/ShortReport-2716.html. Published September 29, 2016. Accessed July 5, 2018.
6Department of Health and Human Services, Assistant Secretary for Policy & Evaluation. Opioid abuse in the U.S. and HHS actions to address opioid-drug related overdoses and death. ASPE Issue Brief. https://aspe.hhs.gov/system/files/pdf/107956/ib_OpioidInitiative.pdf. Published March 26, 2015. Accessed July 5, 2018.