Section 1: Background
The American College of Emergency Physicians recognizes the Opioid Epidemic as one of the most devastating public health crises in a generation. During 2015, drug overdoses accounted for 52,404 U.S. deaths, including 33,091 (63.1%) involving an opioid (natural/semisynthetic opioids, methadone, heroin). That translates into 91 deaths per day resulting from opioid overdoses. Since 1999, the number of overdose deaths involving opioids have quadrupled[i]
. Between 2000 and 2014, nearly half a million Americans died from opioid overdoses.
ACEP recognizes that organized medicine and practice patterns have played a role in creating this epidemic. In 2012, health care providers wrote 259 million prescriptions for opioid pain medication, enough for every adult in the United States to have a bottle of pills[ii]
. However, Emergency Physicians prescribe less than 5% of the nation’s total opioid pills. Emergency Physicians are on the front-lines of the fight against the opioid epidemic. In 2014, there were nearly 1.27 million Emergency Department visits or hospitalizations resulting from opioid related complications, and rate of opioid related Emergency Department visits doubled between 2005 and 2014[iii]
The statistics are sobering, but Emergency Physicians know that these are not merely numbers; each data point represents an individual in our communities that comes to us in his or her darkest moment for help. We are proud to be the specialty that is available 24/7, 365 days a year to care for these patients. Every Emergency Physician has witnessed the scourge of the opioid abuse first-hand. The stories of the countless patients and families devastated by these drugs remain with us and motive us as physicians and as a specialty to develop innovative, multifaceted solutions to combat the Opioid Epidemic.
In response to the Opioid Epidemic, both the State and Federal Government have enacted laws regarding Prescription Drug Monitoring Programs, opioid prescribing, continuous medical education for providers, and naloxone access. ACEP has worked both at the state and national level to find areas of common ground with our representatives to craft the most effective legislation possible while avoiding onerous regulations that have not proven to be effective.
Emergency Medicine Opioid Principles
ACEP urges lawmakers to consider the following principles when developing pain management policies:
- ACEP supports evidence-based, coordinated pain treatment guidelines that promote adequate pain control, health care access and flexibility for physician clinical judgment. Medical specialty societies should be the primary sponsors of these guidelines. ACEP has been actively engaged in developing pain treatment guidelines with the AMA, CDC, FDA, ONDCP and others and creating additional federal work groups or task forces to develop such guidelines would be duplicative. Safe harbor protections should exist for prescribers who follow pain treatment guidelines.
- ACEP supports effective, interoperable and voluntary state prescription drug monitoring programs (PDMPs) that push prescription data to emergency department providers, rather than requiring them to separately sign into and pull the data from the PDMP.
- ACEP supports state and local emergency department efforts to develop innovative programs to decrease opioid prescribing and use, including initiatives such as the state Emergency Department Information Exchange (EDIE) in Washington, Oregon and California, as well as efforts in New Jersey to use alternative, non-opioid pain management protocols supplemented with patient support networks. Alternatives to opioid pain management must be easily accessible to patients, including adequate coverage by insurance companies.
- ACEP supports physician prescribing of naloxone to at-risk patients (per SAMHSA recommendations), naloxone availability for first responders, and education of overdose recognition and safe naloxone administration by non-medical providers. This should be paired with legislation that would make health care providers and lay users of naloxone immune from liability for failure or misuse of bystander naloxone.
- ACEP supports physician co-prescribing of naloxone in conjunction with an opioid prescription for patients at an elevated risk for an intentional or unintentional drug overdose.
- ACEP opposes non-evidence-based public or private limits on prescribing opiates or mandatory opioid-related CME.
- Entitlement pharmacy/physician lock-in programs that account for emergency medical care when a beneficiary is away from their home providers.
- Increased availability and use of prescription recovery sites/programs.
- Expanding manufacturing of opioids with abuse-deterrent properties.
- Partial filling of a Schedule II prescription at the request of the practitioner who wrote the prescription for the patient.
- Increasing the caps for medication assisted treatment by providers who are appropriately trained to dispense narcotics for maintenance/detoxification.
- Enhancing NIH research on the understanding of pain and the development of new therapies.
- Expanded use of drug/treatment courts that balance supervision, support and encouragement as an alternative to the criminal incarceration.
- Modifying patient satisfaction surveys (HCAHPS/EDPEC) to remove the subjective pain questions and develop more objective measures for identification and treatment of pain.
Section 2: Opioid Prescribing Legislation