Saying that prescribing practices — and the neglect of awareness and treatment of substance use disorder — has been a primary driver of the opioid epidemic in the United States, the National Academy of Medicine (NAM) is issuing a new call to action for physicians and other healthcare providers.
“Just as primum non nocere is the foundational starting point for clinician action, it primarily serves as obligatory prelude to the primary duty, deinde benefacere — ‘then, do some good,'” said a panel of NAM experts in a new publication, First, Do No Harm: Marshaling Clinician Leadership to Counter the Opioid Epidemic.
“The opportunities are abundant,” said the authors, a 14-member expert group that included federal officials, such as Carlos Blanco, MD, PhD, director of the National Institute on Drug Abuse’s Division of Epidemiology, and Elinore McCance-Katz, MD, PhD, assistant secretary for mental health and substance abuse at US Department of Health and Human Services.
NAM panel members also included Patrice A. Harris, MD, chair of the American Medical Association Task Force to Reduce Rx Opioid Abuse, and Saul M. Levin, MD, CEO and medical director of the American Psychiatric Association.
The 21-page publication is aimed at physicians, physician assistants, nurses, nurse practitioners, dentists, social workers, behavioral health practitioners, pharmacists, and first responders. It was developed at the request of the National Governors Association, as governors are looking to find solutions to the crisis in their states.
“This paper speaks in particular to the roles of clinicians, both as primary gatekeepers for the appropriate use of these drugs and as first responders to the consequences of their misuse,” said J. Michael McGinnis, NAM Leonard D. Schaeffer Executive Officer, in a media statement. “Moreover, the paper serves as a call to action for the nation’s clinicians to assume their broader leadership responsibilities and advance the health of the communities in which they live and work.”
The authors write that 2.5 million Americans have opioid dependence or use disorder, and more than 1000 people a day present to emergency departments for misusing prescription opioids. Meanwhile, substance use disorders are still widely stigmatized and not discussed or addressed.
“There is a pervasive notion, among many members of the public and even some clinicians, that those who suffer from drug or alcohol dependence may be reaping the consequences of their own choices, that these are character flaws. The science, however, indicates otherwise,” the experts write.
Several key concepts should guide physicians in combatting opioid misuse and treating addiction, according to the new report. Clinicians should:
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Work to reduce stigma by routine emphasis that substance use disorders are chronic neurologic conditions, requiring the sustained, multifaceted team approach typical for other chronic diseases;
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Understand and prioritize nonopioid analgesics and other treatment options in a multimodal approach to pain management;
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When opioids are indicated, use conservative dosage regimens;
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Review prescription-drug monitoring program data;
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Offer naloxone to reduce risk for unintentional overdose;
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Have a clear treatment plan, including steps to slowly taper and discontinue therapy when indicated; and
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For patients who do develop opioid use disorder, provide access to treatment with buprenorphine, methadone, or naltrexone and other forms of medically assisted treatment.
Clinicians can also counsel patients on secure storage and proper disposal of unused opioids and more actively engage with the community to promote the availability of substance use disorder treatment, the panel said.
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