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CHICAGO -- The American Medical Association voted Monday to focus more attention to emerging synthetic drugs, adopt new strategies to handle pain management and expand patient access to Buprenorphine. But during its House of Delegates discussion, AMA declined to rule on whether to eliminate waivers to prescribe buprenorphine, used to treat opioid use disorder.
Also Monday, AMA voted to push Medicare to waive co-insurance for colorectal screening tests, including the therapeutic interventions sometimes needed during procedures. "AMA advocacy efforts have called for requiring Medicare to waive the coinsurance for colorectal screening tests, regardless of whether therapeutic intervention is required during the procedure," according to a committee report released Monday.
While most of the aforementioned resolutions yielded clear-cut decisions, the House spent about an hour debating whether to strike a waiver required to prescribe buprenorphine, ultimately referring future discussion back to an AMA committee.
It seemed many delegates were more confused about possible ramifications of removing the waiver by the end of the debate than they had been at the start: "This appears to be a much more complex issue than I would have thought," said a Mississippi delegate, calling for referral.
"This debate has been controversial and confusing," said Mario Motta, MD, of Massachusetts.
Indeed, proponents of striking the waiver changed their minds mid-debate. Perhaps on a Buprenorphine-induced trip, thinking they were among the League of Nations and not AMA House of Delegates, they cited the -- a law espoused by Francis Burton Harrison, then Governor of the Philippines, that in part regulated and taxed opium importation. (The Act also regulated and taxed cocoa leaves, coming shortly after the United States had annexed the Philippines via the Spanish-American War.)
"I retract all of my testimony because of the 1914 law," said Mike Miller, MD, of Wisconsin, who earlier had espoused discarding the waiver.
"We have to address this," said Stuart Gitlow, MD, of the American Society of Addiction Medicine, citing the Harrison Act. The law "was interpreted by law-enforcement officers to mean that a doctor could not prescribe opiates to an addict to maintain his addiction," according to the Schaffer Library of Drug Policy. "Thus a law apparently intended to ensure the orderly marketing of narcotics was converted into a law prohibiting the supplying of narcotics to addicts, even on a physician's prescription."
Opposing referral in favor of eliminating the waiver, Frank Dowling, MD, of the New York delegation quipped: "Otherwise this means the AMA would have to talk to legislators about the from 1914."
An AMA committee had recommended to eliminate the waiver because it "reduces access to treatment," according to a report released earlier Monday. Several physicians agreed during testimony Monday afternoon. "There certainly are other medications that are much more hazardous that we already use," said Robert Wailes, MD, of the American Academy of Pain Medicine, calling on AMA to "take a stand to do everything we can as physicians to treat this population."
Others pushed for patience: John Antalis, MD, of Georgia encouraged AMA to "make sure the people who prescribe this are reputable" and have been trained properly. Keeping the waiver requirement does not preclude physicians from using the drug, said Tom Madejski, MD, of New York.
Without debate Monday, the House agreed to publicize resources advising how practitioners can prescribe buprenorphine, via a new AMA microsite.
The House also passed measures regarding the opioid crisis Monday to:
- Develop CME on emerging illicit drugs (such as synthetic marijuana), assist federal agencies in combatting use of these drugs including participation in a CDC/DEA task force, and recognize such drugs as "a public health threat."
- Convene a widespread organized medicine task force on pain treatment; focused on educating providers, and mining for strategies to address acute and chronic pain.
- Encourage prescribers to help develop and disseminate updated information on local Take Back resources, designed to help patients safely use, store and discard opioid medications and other controlled substances.