AMA: Effective pain management with prevention of prescription drug abuse

AMA: Effective pain management with prevention of prescription drug abuseA guest column by the American Medical Association, exclusive to

Prescription drug abuse has reached crisis levels: overdoses and deaths from opioid analgesics have more than quadrupled in the U.S. since 1999. At the same time, a great deal of human pain and suffering remains inadequately treated. In fact, according to the Institute of Medicine, at least 100 million Americans suffer from chronic pain, creating an imperative to better prevent and manage persistent pain. As policymakers craft solutions to address prescription drug abuse, diversion, overdose and death, it is critical that we do not unintentionally discourage physicians from appropriately treating pain or reduce access to prescription drugs for patients who are suffering.

The American Medical Association (AMA) has been working with the nation’s state and specialty medical societies and many national organizations to identify and support workable solutions to curb prescription drug abuse, including the National Governors Association, Federation of State Medical Boards and others. This also includes developing educational programs on pain management and prescription drug abuse. Although some chronic pain sufferers benefit from prescription opioids on a long term basis, many others do not benefit or suffer harm. A multidisciplinary approach is often needed to manage these patients, and educational opportunities that focus on appropriate pain management can help ensure physicians have access to the information they need to properly and safely assess, treat and monitor patients in pain.

Over the past decade, the AMA has offered a pain management continuing education program. This program has been recently updated to provide physicians with up-to-date information on the assessment and management of pain. This continuing medical education (CME) series is a comprehensive educational resource comprised of 12 modules addressing numerous clinically important aspects of pain management. Subjects covered include:

  • pain mechanisms and assessment
  • an overview of management options
  • the management of cancer and persistent non-cancer pain, including neuropathic pain
  • the universal precautions approach to the clinical use of opioid analgesics
  • the need to appropriately structure therapy and manage the risks associated with these substances
  • pain management for specific populations, disorders or conditions

Funding for the program was made possible by support from the Prescribers’ Clinical Support System for Opioid Therapies, a group of health care organizations led by the American Academy of Addiction Psychiatry that received grant funding from the Substance Abuse and Mental Health Services Administration.

The AMA offers physicians other educational resources to help combat prescription drug abuse and diversion. We’re also continuing to develop a series of 12 free webinars for prescribers on various topics related to the intersection of addiction, pain management and opioid use. Six webinars have already been held and are archived for on-demand viewing.

However, the availability of prescriber education alone will not solve this crisis. The AMA has advocated that a public health based, multipronged approach and coordinated solutions are required. Essential elements include real-time prescriber access to patient prescription data, patient and caregiver education, proper storage and disposal of controlled substances and targeted enforcement actions against “pill mills” and criminal activities contributing to diversion. Expanded use of drug courts would also be beneficial, as these courts can provide addicted patients with the medical attention, support and accountability needed to help achieve and sustain recovery.

Physicians often have difficulty finding and placing patients in addiction treatment and recovery programs. Regulatory burdens surrounding the use of buprenorphine and Suboxone® can make it difficult for physicians to successfully treat patients addicted to prescription drugs in an office-based setting. A far greater effort is needed on the treatment and recovery side of this crisis to help stem the tide of addiction, overdose and death.

We will continue to work with policymakers to balance the physician’s ethical obligation to treat patients who are suffering from pain against the need to identify drug seekers and prevent abuse, unintentional overdose and death from prescription drugs. To learn more about efforts to combat prescription drug abuse and diversion, visit Combating Prescription Drug Abuse and Diversion.

Ardis D. Hoven is president, American Medical Association

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  • Janice Lynch Schuster

    It’s a remarkable read and a horrific situation. In the late 1990s/early 2000s, I was involved in advocacy efforts to make it easier for physicians to prescribe pain medications for patients who were nearing the end of life. Eventually, those uses expanded, and now, from what I’ve heard, we have enough Oxycontin in America to give a 30-day supply to every man, woman, and child. Letting that genie out of the bottle has had severe, dire consequences. I have watched the teenage children of friends develop addictions to pain medication, which have morphed into heroin addicitons….to what end? So that big pharma raked in its profits.

    I have also become a resident in the terrible land of chronic pain, and doctors there have little to offer in the way of comfort or relief. Percocet has become a near-constant companion. In the course of using it, I have come to be treated as though I were a pill-seeking junkie, and any and every health care encounter I now have includes a discussion of this medication (although I am not, in fact, on a high dose, nor do I use more than recommended).

    To be sure, we need alternative coping mechanisms: meditation, for instance, and stress management. But as I explore the online patient forums where people agonize over chronic pain conditions, I see sheer human suffering, and not much to relieve it.

    I hope the AMA finds an antidote to this sorry state of affairs-no magic pilll, no silver bullet, but something, somewhere that relieves suffering, rather than perpetuates it.

  • Leo Lombardo

    I agree that better continuing education regarding pain is important. One aspect of chronic pain that is not mentioned in this article is the role of fellowship-trained comprehensive pain specialists. Under the current ACGME structure, new pain doctors now have mandatory multidisciplinary training in Anesthesiology, PM&R, Neurology, and Psychiatry, and are well prepared to devise more effective treatment plans than long-term opioids alone. Although a specialist referral does not make sense for every case of persistent pain, I encourage primary care physicians near my practice in Ventura, CA to consider consulting a pain physician early if pain is persisting without progress.

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