American Medical Association president calls on doctors to curb opioid prescriptions to combat addiction

Steven Stack, emergency physician and AMA president is calling on physicians to take the lead in combating the nation's growing opioid dependence, writing in a public letter that opioid addiction too often "has started from a prescription pad" and asking doctors to curb the issuing of opioid prescriptions.

Citing "well-intended" but "flawed" public policy that led doctors to treat pain more aggressively, Stack advised physicians to avoid prescribing opioids to patients with non-cancer pain, except in cases where the benefits are expected to outweigh the risks -- arguing that non-pharmacological interventions would be preferable.

In instances of post-operative care and acutely injured patients, Stack warned against prescribing too many opioids at too high a dose, and said doctors should not prescribe merely one on the basis of a patient's convenience.

[Also: CMS, Joint Commission pressed to change policies that promote opioid pain medicine overuse]

He also wrote that doctors should register for, and use, their state Prescription Drug Monitoring Program to assist in patient care when considering the use of any controlled substances.

As of April, Missouri was the only state that had not implemented some kind of PDMP -- a statewide database tracking narcotics prescriptions, which doctors and pharmacists can check to catch signs of abuse or addiction and to intervene if necessary.

Earlier this year, dozens of medical organizations and consumer advocacy groups sent a letter to the Joint Commission, and a petition to the Centers for Medicare and Medicaid Services, asking for policy changes in an effort to reduce the over-prescribing of opioid pain relievers.

The petition calls for the removal of pain questions from the Hospital Consumer Assessment of Healthcare Providers and Systems Survey, the agency's patient satisfaction query used to determine hospital reimbursement rates. Petitioners said CMS financially incentivizes hospitals to obtain high scores on HCAHPS Survey questions.

[Also: Insurers picking up more of the cost of opioid prescriptions, CDC study says]

Physicians prescribed opioids, often in high doses, in more than half of 1.14 million nonsurgical hospital admissions over the past 20 years, according to a recent study in the U.S. National Library of Medicine, National Institutes of Health.

In his letter, Stack advocated for identifying and assisting patients with opioid use disorder in obtaining evidence-based treatment, and co-prescribing naloxone to patients who are at risk for overdose.

"As physicians, we are on the front lines of an opioid epidemic that is crippling communities across the country," he wrote. "We must accept and embrace our professional responsibility to treat our patients' pain without worsening the current crisis. These are actions we must take as physicians individually and collectively to do our part to end this epidemic."

[Also: Opioid epidemic causing more hospitalizations, increasing hospital costs, study finds]

In February, Dr. David Edwards, clinical chief of pain at Vanderbilt University Medical Center in Nashville, Tennessee, said in a statement that for many surgical and nonsurgical patients, opioids are still the best and most potent way to treat pain. But evidence indicates that the rise of opioid use, particularly when used in isolation, does not correspond to better pain control or patient satisfaction; rather, it contributes to poor patient outcomes and what Edwards called  "a societal burden" when patients are eventually discharged on higher-than-ever doses.

"Society suffers when patients suffer," said Edwards. "The cost of risk-managing prolonged opioid therapy for an ever-increasing pool of patients on opioids overextends the medical system."

Twitter: @JELagasse