Archive for December, 2011

Update from the 2011 AMA Interim Meeting

by Chad D. Kollas, MD FACP FCLM FAAHPM—AAHPM Delegate to the AMA

The American Medical Association (AMA) held its Interim Meeting in a revitalized New Orleans from November 12-15, and AAHPM’s representatives enjoyed a productive meeting—while also partaking of Louisiana’s legendary cuisine! Alternate delegate Dennis Pacl, MD FACP, and I were pleased to welcome Patrick White, MD, AAHPM’s 2011-12 Delegate to the Resident and Fellow Section of the AMA, to our delegation. Dr. White is a palliative care fellow at the University of Pittsburgh, and he brought a wealth of youthful enthusiasm and the wisdom gained from his world travels to the proceedings of the AMA. Advocacy serves as the focus of the AMA’s Interim Meeting, and we enjoyed the good fortune of advancing several of the Academy’s key public policy priorities.

Reducing Prescription Drug Abuse

Meeting attendees awoke Nov. 14, to find the front page of their complimentary USA Today declaring, “Surge in Babies Addicted to Drugs.” The article dramatically underscored the urgency of one of the main issues addressed at the Interim Meeting — prescription drug abuse, including the increasing trend in deaths from opioid medications. The AAHPM delegation planned its strategy to advance Resolution 907, which called for the AMA to promote a variety of measures designed to address the problem. We secured support from the Pain and Palliative Medicine Specialty Section Council (PPMSSC) to offer testimony at live, on-site Reference Committee Hearings, where we emphasized the urgency of a response, noting that recent changes in state laws, such as Florida’s Statute 456.44, would impose new, strict rules on physicians prescribing controlled medications as early as January 2012. In the end, an amended resolution was adopted as AMA policy. It calls on the AMA to 1) promote physician education and training on controlled substances, 2) encourage screening of patients for drug misuse, 3) provide materials to physicians to promote treatment of their patients’ unhealthy behaviors, and 4) encourage physicians to use state prescription monitoring programs. The resolution’s sponsor offered gratitude to the Academy and PPMSSC for helping to advance the policy.

Visit with ONDCP Director
The Academy’s ongoing efforts to balance patients’ legitimate access to controlled medications while improving public safety received a big boost that was set up by AAHPM’s Capitol Hill Days in September 2011. This fly-in visit to Washington, DC, allowed AAHPM physicians and staff to meet with federal legislators and regulators to advance the Academy’s public policy priorities, including with Regina LaBelle, Policy Director for the Office of National Drug Control Policy (ONDCP). In follow up, AAHPM was able to secure a face-to-face meeting with ONDCP Director, R. Gil Kerlikowske. He was speaking at the AMA meeting as part of a panel discussion focused on the nation’s prescription drug abuse crisis .

We met directly with Kerlikowske and LaBelle for about 35 minutes to discuss the problem of prescription drug abuse. We helped them understand the special access needs of patients’ receiving palliative care while emphasizing the Academy’s ongoing commitment to patient and public safety. We discussed AAHPM’s collaborative efforts to prepare for prescriber education mandated by the opioid REMS, and we provided personal insights into providing palliative care in an increasingly challenging healthcare environment. Near the end of the meeting, we offered to serve as a resource for ONDCP in its effort to combat prescription drug abuse, and the directors both expressed genuine appreciation. They also accepted AAHPM’s offer to attend the Pain and Palliative Medicine Caucus Meeting, where they continued their positive discussion with AAHPM and PPMSSC members. This special opportunity will help to grow AAHPM’s relationship with another important federal regulatory body, very much in the way that the Academy’s relationship with FDA has evolved productively through the process of developing the opioid REMS.

Advance Care Planning

AAHPM’s delegation helped achieve adoption of Resolution 005, “Encouraging Standardized Advance Directive Forms Within States,” offering support in onsite hearings. The amended resolution was adopted by the AMA, and the Medical Student Section that sponsored it expressed gratitude to AAHPM for its support. Promoting advance care planning, like assuring patient access to medications used in palliative care, stands as one of the Academy’s public policy priorities. Successfully supporting Resolution 005 therefore furthered AAHPM’s policy goals, built upon existing AMA policies that help promote advance directives and advance care planning, and helps keep this issue in the public eye in a positive manner.

National Drug Shortages

The AMA plans to release a detailed report about national drug shortages, a problem that has profoundly affected palliative care specialists over the last several years. In the meantime, the AMA House passed a resolution that declares the issue of national drug shortages to be a “public health emergency.” This issue particularly resonated with colleagues from the American Society of Clinical Oncology (ASCO), who–like AAHPM–are members of the PPMSSC. The AAHPM Delegation will report on findings of the AMA study of national drug shortages when that information becomes available, which should be in June 2012.

A Fellow’s View of the AMA Meeting

by Patrick White

Patrick White is a Hospice and Palliative Medicine Fellow at the University of Pittsburgh and AAHPM’s delegate to the American Medical Association (AMA) Resident and Fellow Section.

Attending the American Medical Association (AMA) Interim Meeting in New Orleans was an amazing experience. From my first alligator sausage through our last meeting with the head of the White House Office of National Drug Control Policy, it was certainly one of the most entertaining and educational weeks of my fellowship. I was pleasantly surprised to see how many of the issues we discussed are relevant to my future career: from advocating for standardized advanced directive forms within states, to addressing shortages of crucial medications like morphine, to finding ways to reduce prescription drug abuse/misuse/diversion.

I was struck by how both my peers and the senior AMA delegates were interested in learning about how the hospice and palliative care community viewed the impact of pending legislation. I watched our own Chad Kollas chair the Pain and Palliative Medicine Specialty Section Council – a group encompassing 9 specialty organizations from addiction medicine to clinical oncology – advocating our positions on issues while building relationships with related specialties to further advance palliative medicine. The greatest highlight came when Jacqueline Kocinski, AAHPM Director of Health Policy and Government Relations, obtained a meeting with Gil Kerlikowske, Director of the White House Office of National Drug Control Policy. He was in New Orleans to address the AMA as part of a panel discussing prescription drug abuse. Our delegation discussed the unique concerns of palliative care and hospice physicians who frequently need to obtain schedule II opioids emergently for patients who are in acute pain crisis. Director Kerlikowske shared that he wanted additional input from AAHPM as new initiatives designed to stem the tide of opioid addiction and death move forward, helping to preserve our timely access to vital pain medications.

Observing the impact of these small meetings made me realize just what a huge impact groups like the AAHPM and AMA can have in shaping new health care policy. With so many crucial issues facing both palliative care and medicine as a whole, it is both an exciting and challenging time to be involved. I am grateful for the opportunity to see first-hand just how effective our voice can be and to work with people dedicated to advancing palliative medicine.