Reversing the opioid epidemic in Texas

The heartbreaking story of Miles McEntee’s tragic overdose is a reminder of what is at stake in the fight against the opioid epidemic.

The harsh reality is that overdoses from prescription opioids and heroin take the lives of tens of thousands of Americans each year — our friends, family and even our youth. The Centers for Disease Control and Prevention identify prescription drug abuse as the fastest-growing drug problem in the country. In 2014, more than 2,600 Texans died from drug-related overdoses.

Today, thanks to new laws in the Lone Star State that were supported by Texas physicians, patients can obtain the life-saving medication naloxone directly from their neighborhood pharmacy. For many individuals, access to naloxone has been the difference between life and death, and physicians can help in two ways: by talking with their patients about naloxone and co-prescribing it to patients who are at risk of overdose.

This also is where insurance companies can make a difference. Naloxone can and will save lives, and while co-prescribing the drug is important, it’s simply not enough. Naloxone must be accessible and affordable. For this to happen, insurers must cover the medication and offer it to individuals at a reasonable price. While new laws in Texas provide for increased access, patients still need to know that the medication will be available when they ask for it — and that it will be affordable.

At the same time, the American Medical Association also is urging physicians to avoid initiating opioids for new patients with chronic non-cancer pain unless the expected benefits are anticipated to outweigh the risks. Non-pharmacologic therapy and non-opioid pharmacologic therapy should be considered when clinically indicated, and it is essential that patients have access to non-opioid and non-pharmacologic therapies.

Unfortunately, many of these options may not be covered by insurance, or they may have limitations on care. Patients need to know that if their physician prescribes physical therapy or behavioral or cognitive therapy, the insurance company won’t put an arbitrary limit on that care.

In addition, it is advisable to limit the amount of opioids prescribed for post-operative care and acutely injured patients. Physicians should prescribe the lowest effective dose for the shortest possible duration for pain severe enough to require opioids. Ultimately, physician professional judgment and discretion is important in this determination.

The data show that Texas physicians already are doing this. Texas has seen a 16.8 percent decrease in prescriptions for opioid analgesics — improving on the nationwide decrease of 10.6 percent.

The opioid public health epidemic will not be solved with a one-size-fits-all approach. We’re pleased that physicians, legislators, and other state leaders are all working to reduce the harms of the epidemic in Texas.

Now that we have the laws in place, it’s up to policymakers, stakeholders in the medical community, and the insurance industry to be sure that they are implemented and build on the progress being made — in order to save lives in Texas and across the country.

Patrice A. Harris

Chair, American Medical Association Board of Trustees

@patriceharrismd

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