Daniel Blaney-Koen, American Medical Association, presented on The Nation's Opioid Epidemic: Are we Asking the Right Questions? at the State Legislative Conference on November 6, 2015.

1. The nation’s opioid epidemic:
Are we asking the right questions?

2. © 2015 American Medical Association. All rights reserved.
A. Are the number of unintentional overdoses and deaths due to
opioids going up or down?
B. Are the number of prescriptions for opioids going up or down?
C. Do mandates for prescribers to check prescription drug monitoring
programs lower prescribing rates or mortality rates?
D. Do mandates for prescribers to take “pain” or “prescribing”
education lower prescribing rates or mortality rates?
E. Why don’t more physicians provide medication assisted treatment?
F. Do you know a physician who has co-prescribed naloxone?
2

3. © 2015 American Medical Association. All rights reserved.
Drug Poisoning Deaths Involving Opioid Analgesics and
Heroin: United States, 1999–2013
% CHANGE
2006-2013
+ 17%
+ 184%
Sources: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Unintentional Injury
Prevention
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
opioid analgesic 4,030 4,400 5,528 7,456 8,517 9,857 10,92813,72314,40814,80015,59716,65116,91716,00716,235
heroin* 1,963 1,843 1,784 2,092 2,084 1,879 2,010 2,089 2,402 3,041 3,278 3,036 4,397 5,927 8,257
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000
2006-2013 mortality data

4. © 2015 American Medical Association. All rights reserved.
4
Drug overdose rates by state

5. © 2015 American Medical Association. All rights reserved.
5

6. © 2015 American Medical Association. All rights reserved.
6

7. © 2015 American Medical Association. All rights reserved. 7
517,000

8. © 2015 American Medical Association. All rights reserved. 8

9. © 2015 American Medical Association. All rights reserved.
National prescribing trends
• Overall utilization of opioids
– 2013: 251,814,805
– 2014: 244,457,347
• Growth, opioid utilization
– 2014: 2.9% decrease
• Growth, hydrocodone utilization
– 2014: 10% decrease
•
9

10. © 2015 American Medical Association. All rights reserved. 10
State Growth in opioid utilization (2013-2014) PDMP mandate?
AR 1.3 No
NV 1.3 Yes
NM 1.0 Yes
VT -0.6 Yes
DE -1.1 No – based on judgment
WV -1.3 Yes
SC -1.4 No
FL -1.6 No
OR -1.9 No
KY -1.9 Yes
CA -2.3 (ranked 26th) No
UT -2.4 No
TX -3.3 No
MA -3.3 Yes
TN -3.4 Yes
OH -4.1 Yes

11. © 2015 American Medical Association. All rights reserved.
State Age-adjusted drug poisoning death rate (CDC/NCHS,
NVSS)
Growth in opioid utilization
2013-2014 (%) (IMS Health)
CA Rate significantly lower than overall US rate -2.3 (ranked 26th)
TX Rate significantly lower than overall US rate -3.3
MA Rate not significantly different from overall US rate -3.3
OR Rate not significantly different from overall US rate -1.9
AR Rate not significantly different from overall US rate 1.3
FL Rate not significantly different from overall US rate -1.6
DE Rate not significantly different from overall US rate -1.1
SC Rate not significantly different from overall US rate -1.4
VT Rate not significantly different from overall US rate -0.6
NM Rate significantly higher than overall US rate 1.0
OH Rate significantly higher than overall US rate -4.1
KY Rate significantly higher than overall US rate -1.9
TN Rate significantly higher than overall US rate -3.4
NV Rate significantly higher than overall US rate 1.3
UT Rate significantly higher than overall US rate -2.4
WV Rate significantly higher than overall US rate -1.3

12. © 2015 American Medical Association. All rights reserved.
So why are mandates still so attractive?
• 244,000,000+
• 16,000+
12

13. © 2015 American Medical Association. All rights reserved.
• AMA Task Force to Reduce Opioid Abuse
– Increase registration and use of PDMPs
– Ensure safe, evidence-based prescribing
– Support comprehensive pain care; reduce the stigma of pain
– Reduce the stigma of substance use disorder; increase access to treatment
– Increase access to naloxone, Good Samaritan protections
13

14. © 2015 American Medical Association. All rights reserved.
March 2015: U.S. Dept. of Health and Human Services
• Opioid prescribing practices to reduce opioid use disorders and
overdose
• The expanded use of naloxone, used to treat opioid overdoses
• Expanded use of Medication-assisted Treatment (MAT) to reduce
opioid use disorders and overdose
14

15. © 2015 American Medical Association. All rights reserved. 15

16. © 2015 American Medical Association. All rights reserved.
October 2015: Charleston, West Virginia
“We can’t fight
this epidemic
without removing
stigma.”
President Obama,
10/21/2015
16

17. © 2015 American Medical Association. All rights reserved.
Is this how to reduce the stigma?
• Two-year limit on treatment?
• Formularies that restrict types of treatment?
• Drug courts that believe in abstinence?
• Fail first therapies for MAT?
• Threat of involuntary commitment?
17

18. © 2015 American Medical Association. All rights reserved. 18

19. © 2015 American Medical Association. All rights reserved.
States with naloxone access laws, September 2015: Network for Public Health Law

20. © 2015 American Medical Association. All rights reserved.
States with overdose Good Samaritan laws, September 2015: Network for Public Health Law

21. © 2015 American Medical Association. All rights reserved.
A. Are the number of unintentional overdoses and deaths due to
opioids going up or down?
B. Are the number of prescriptions for opioids going up or down?
C. Do mandates for prescribers to check prescription drug monitoring
programs lower prescribing rates or mortality rates?
D. Do mandates for prescribers to take “pain” or “prescribing”
education lower prescribing rates or mortality rates?
E. Why don’t more physicians provide medication assisted treatment?
F. Do you know a physician who has co-prescribed naloxone?
21

22. © 2015 American Medical Association. All rights reserved. 22
For more information:
Daniel Blaney-Koen, JD
Senior Legislative Attorney
Advocacy Resource Center
(312) 464-4954
daniel.blaney-koen@ama-assn.org