In a letter published in the BMJ addressed to current American Medical Association president Dr. Susan Bailey, PROP leaders address concerns regarding the AMA’s public statements on opioid prescribing for pain.
In 1995, the AMA wrote, in a patient guide on back pain, “[Opioids] are usually prescribed for short periods, however, because they are addictive and are not necessary for long-term pain control.” This prudent message still holds true today, and is consistent with current recommendations from the CDC, the VA, the American Academy of Neurology and the American College of Physicians. Unfortunately, by the early 2000s, the AMA’s position on opioid use took a U-turn. The AMA began downplaying opioid risks and publishing medical education that promoted long-term opioid use. And as opioid prescribing soared, the AMA weighed in against more forceful regulation of opioid manufacturers. During this time, AMA and the AMA Foundation accepted hundreds of thousands of dollars from Purdue Pharma and other opioid makers.
Five years ago, when the CDC announced its plan to issue a guideline calling for more cautious opioid use, the opioid industry attempted to block its release. Not surprisingly, the AMA, and other professional groups funded by the opioid industry, participated in the effort to block release of the guideline and/or water down its recommendations, especially recommendations calling for dose and duration limits. AMA even asked CDC to increase the suggested duration of use for acute pain and it asked CDC to remove its maximum dose recommendation of 90 MME/day (equivalent to about 18 tablets of hydrocodone 5mg in one day).
AMA has continued to collaborate with industry-funded opioid advocacy organizations and continues to oppose guidance for prescribers with suggested limits on duration and dose. In supporting its position, the AMA has disingenuously pointed to a soaring increase in deaths involving illicit opioids, suggesting that the CDC is to blame, even though illicit opioid deaths began increasing rapidly in 2012, four years before the CDC Guideline was published.
We are hopeful that AMA will seriously consider the concerns outlined in our letter. When weighing in on an urgent public health crisis, the AMA should base it’s positions and statements on the best available medical evidence.
Read the BMJ article
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