A letter published February 17 in BMJ, co-authored by Physicians for Responsible Opioid Prescribing (PROP), rebuts the claim made by an executive with the American Medical Association, who wrote to the National Center for Injury Prevention and Control’s chief medical officer that “the nation no longer has a prescription opioid driven epidemic . . . we can no longer afford to view increasing drug related mortality through a prescription opioid myopic lens.”
James Madara, chief executive of the AMA wrote the letter to the National Center for Injury Prevention and Control’s chief medical officer, Deborah Dowell. Madara also wrote to Powell, that the US’s opioid epidemic “has never been just about prescription opioids” and encouraged the Centers of Disease Control and Prevention (CDC) to “take a broader view of how to help ensure patients have access to evidence based comprehensive care that includes multidisciplinary, multimodal pain care options as well as efforts to remove the stigma that patients with pain experience on a regular basis.”
Doctors with PROP suggested that the AMA’s view that there’s no longer an opioid epidemic sends a “strong message that opioid prescribing for pain is no longer problematic, and that the CDC’s recommended guardrails are no longer needed.”
The physicians also disapproved of the AMA’s call for states to remove “arbitrary dose, quantity, and refill restrictions on controlled substances” to allow patients to obtain the medications they needed.
There is compelling evidence that those with opioid addiction were introduced to the pain-relieving drugs via medical prescription to treat chronic pain, the physicians argued, adding that dose and duration restrictions are not arbitrary, but rather “based on considerable evidence of when harm far exceeds benefit.
Evidence-based opioid prescribing guidance on dose and duration is needed now more than ever, PROP’s letter suggested, although the physician group did acknowledge that there have been cases in which the CDC’s recommendations have been “misapplied as strict limits”
In addition, the PROP physicians write that the AMA’s moral argument that opioids are needed so that people do not suffer needlessly “should apply only to short term pain management where there is proven benefit, and not to long term pain management where evidence of benefit is largely anecdotal, and there is compelling evidence of harm.”
Failure to acknowledge or promulgate the distinction is “a repeat of the pharmaceutical industry’s playbook that led to an epidemic of opioid use disorder,” PROP concluded.