The American Medical Association (AMA) issued a new report on Thursday documenting how California’s physician leadership is advancing the fight against the opioid crisis.

The report found a statewide decrease in opioid prescribing, as well as an increase in the use of California’s prescription drug monitoring program (PDMP), number of physicians trained and certified to provide patients with buprenorphine for the treatment of opioid us disorder, and naloxone access. California also saw two consecutive years of decreases in prescription-related opioid deaths and surpassed the national average for prescription decreases between 2014 and 2017.

“This report demonstrates that California physicians have made significant strides against the opioid crisis by expanding access to effective treatments for substance use disorders,” said California Medical Association (CMA) President Theodore M. Mazer, M.D. “CMA will continue to lead the nation in implementing effective solutions to reduce opioid abuse and ensure that patients have timely access to medically necessary treatment.”

Other key findings include:

• Opioid prescribing decreases for fifth year in a row. Physicians have decreased opioid prescriptions nationwide for the fifth year in a row. Between 2013 and 2017, the number of opioid prescriptions decreased by more than 55 million – a 22.2 percent decrease nationally. In California, opioid prescribing decreased by 24.3 percent, surpassing the national average since 2014.
• PDMP registration and use continues to increase. In 2017, health care professionals nationwide accessed state databases more than 300.4 million times – a 148 percent increase from 2016. States with and without mandates to use the PDMP saw large increases. California has increased utilization of its state database by more than 6.4 million since 2014.
• Physicians enhancing their education. In 2017, nearly 550,000 U.S. physicians and other health care professionals took continuing medical education classes and other education and training in pain management, substance use disorders and related areas. California physicians are required to complete 12 hours of continuing medical education in pain management and the appropriate care and treatment of the terminally ill. CMA offers physicians who prescribe opioids and other controlled substances access to up-to-date information on a wide range of issues, including how to provide treatment that meets the community standard of care, and how to manage the risks that can come with prescribing opioids.
• Access to naloxone rising. Nationwide, naloxone prescriptions more than doubled in 2017, from approximately 3,500 to 8,000 naloxone prescriptions dispensed weekly. So far in 2018, that upward trend has continued; as of April, 11,600 naloxone prescriptions are dispensed weekly - the highest rate on record. In California, naloxone has been available without a prescription since 2015.
• Treatment capacity increasing. As of May this year, there were more than 50,000 physicians certified to provide buprenorphine in office for the treatment of opioid use disorders across all 50 states – a 42.4 percent increase in the past 12 months.

“We encourage policymakers to take a hard look at why patients continue to encounter barriers to accessing high quality care for pain and for substance use disorders,” said Patrice A. Harris, M.D., M.A., chair of the AMA Opioid Task Force. “This report underscores that while progress is being made in some areas, our patients need help to overcome barriers to multimodal, multidisciplinary pain care, including non-opioid pain care, as well as relief from harmful policies such as prior authorization and step therapy that delay and deny evidence-based care for opioid use disorder.”

To further address the opioid crisis, CMA urges policymakers and insurers to remove barriers to care for pain and substance use disorders. These steps include:

• All public and private payers should ensure that their formularies include all FDA-approved forms of medication assisted treatment (MAT) and remove administrative barriers to treatment, including prior authorization. CMA is sponsoring Assembly Bill 2384 (Arambula), which would remove burdensome insurance barriers to MAT and make it easier for patients to access effective treatment.
• Policymakers and regulators should increase oversight and enforcement of parity laws for mental health and substance use disorders to ensure patients receive the care that they need.
• All public and private payers – as well as pharmacy benefit management companies – must ensure that patients have access to affordable, non-opioid pain care.
• The Drug Enforcement Agency should fix its antiquated and burdensome process for e-prescribing controlled substances, which has created impediments to physician participation. More than 90 percent of physicians e-prescribe, yet only 21 percent e-prescribe controlled substances.
• Put an end to stigma. Patients with pain or substance use disorders deserve the same care and compassion as any other patient with a chronic medical condition.

Patients seeking MAT still struggle to access it with insurance utilization management policies posing a significant obstacle. AB 2384 would help to ensure that those seeking treatment for substance use disorders are able to receive it without long, arduous delays and waiting for health plan approval.  

“While California has achieved promising outcomes with its multi-faceted approach to addressing opioid misuse, more emphasis should be placed upon increasing access and availability of medication-assisted treatment, and reducing stigma associated with drug use and addiction,” said Dr. Mazer. “Congress and the California legislature must enact policies that focus on treatment for those suffering from substance use disorders, and ensure access to high-quality, evidence-based treatment.”

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About the American Medical Association: The American Medical Association is the premier national organization providing timely, essential resources to empower physicians, residents and medical students to succeed at every phase of their medical lives. Physicians have entrusted the AMA to advance the art and science of medicine and the betterment of public health on behalf of patients for more than 170 years. For more information, visit AMA-assn.org.

The California Medical Association represents the state’s physicians with more than 43,000 members in all modes of practice and specialties. CMA is dedicated to the health of all patients in California. For more information, please visit CMADocs.org, and follow CMA on Facebook, Twitter, LinkedIn and Instagram.