WASHINGTON — The U.S. Department of Justice plans to hold providers accountable per a new large-scale effort to tackle the opioid crisis, Deputy Attorney General Rod Rosenstein reiterated here Wednesday.
Addressing the annual policy conference sponsored by America’s Health Insurance Plans, Rosenstein said the new opioids task force announced by Attorney General Jeff Sessions last week will hold everyone accountable; he then specifically cited physicians.
The proliferation of prescription painkillers, including opioids, has countered the ethos of “do no harm,” Rosenstein said, noting that the average American life expectancy has decreased along with the 21st century opioid spread — after nearly doubling over a century. “These drugs have caused a lot of collateral damage,” Rosenstein said, including costing American healthcare more than $1 trillion this century.
In addition to the Task Force, Rosenstein cited as another solution the Justice Department’s involvement with the new Joint Criminal Opioid Darknet Enforcement team; it has been established in large part to counter the flow of painkillers, especially synthetics such as fentanyl, from foreign countries into the U.S.
“We ought to all be about prevention,” he said, citing over-prescription as a major cause of the opioids crisis.
Rosenstein asked insurance companies to utilize their monitoring systems to identify patients receiving too many painkillers and those receiving them for conditions that don’t warrant them. “We recognize that you have a financial incentive” to limit prescriptions, he noted.
Rosenstein also encouraged providers, insurers and others to follow the CDC’s 2016 opioid guidelines.
The deputy attorney general spoke just before a panel on the opioid crisis featuring Patrice Harris, MD, chair of the American Medical Association’s Opioid Task Force; Adriane Fugh-Berman, MD, a Georgetown University professor who leads the PharmedOut initiative; and Nick Szubiak, LCSW, of the National Council for Behavioral Health.
“The pharmaceutical industry is almost completely responsible for this epidemic,” Fugh-Berman said, citing misleading advertising and their practice of hiring “thought leaders” to shame providers into prescribing more opioids. These individuals told physicians they were “torturing our patients” by not issuing painkillers whenever they complained of pain.
Pharmaceutical companies “misused” medical literature by consistently citing small-scale studies and research letters as evidence for supporting opioid prescriptions, she said. They also published ghostwritten articles in medical and consumer publications, and launched disease awareness campaigns. In addition, they funneled money to medical advocacy groups, including the U.S. Pain Foundation ($2.9 million during 2012-2017) and the American Academy of Pain Medicine ($1.2 million) to promulgate messages such as “restricting opioids in any way disadvantages pain patients” and “the needs of patients with [opioid use disorder] must be balanced with the needs of pain patients.”
Such practices have not completely abated, she said. One in 12 physicians accepted money from opioid manufacturers from 2013-2015 totaling $46 million. Fugh-Berman also reminded the crowd that the phrase “abuse deterrent” does not necessarily mean “less addictive.”
She encouraged practitioners to suggest patients try alternative methods for treating pain, such as regular exercise, acupuncture and transcutaneous electrical stimulation. “Some of these treatments are as effective or more effective for pain than opioids,” one of her presentation slides said.
Alternative treatments indeed need to be more readily available to patients, said Melinda Becker, who directs a National Governors Association Health Division center.
Harris suggested decreasing administrative burdens for practitioners, such as prior authorization requirements, especially when treating patients with substance use histories.
Physicians are already making progress addressing the opioid crisis, Harris noted. Healthcare professionals more than doubled queries with prescription monitoring programs during 2014-2016, according to an AMA survey; a QuintilesIMS report noted that total opioid prescriptions declined from 259 million to 215.5 million from 2012-2016.
Harris directed the audience to the AMA Task Force’s recommendations and to its dedicated opioid web page.
Szubiak listed several resources needed to combat the crisis, including:
- Intensive case management
- Recovery supports
- Patient navigators
- Certified community behavioral health clinics
- Shifting healthcare to value-based care
- Tracking patients who diverge from care plans
Barriers must also be overcome, Szubiak said, citing providers’ bias against opioid users, and other perceptions within American healthcare that have led to users being regarded as criminals. These patients should instead be educated about prevention and treated.
Fugh-Berman is a paid expert witness at the request of plaintiffs in litigation regarding pharmaceutical marketing practices.