AMA House of Delegates Meeting Update

The AMA Interim House of Delegates met in Dallas from November 8-11. Stuart Gitlow MD, MPH, MBA, DFAPA, current ASAM President, serves as ASAM’s Delegate to the AMA House of Delegates (HOD) and Ilse Levin is ASAM’s Alternate Delegate. In addition, Dr. Gitlow chairs the AMA’s Council on Science and Public Policy; Ilse Levin, DO, Ex-Officio, AMA Alternate Delegate and Mike Miller, MD, FASM, Past President are also members. Resolutions passed at this meeting of interest to ASAM members are listed below.

1) D-450.962 Pain Management and the Hospital Value-Based Purchasing Program- This resolution urges the Centers for Medicare & Medicaid Services (CMS) to: (a) evaluate the relationship and apparent disparity between patient satisfaction, using the Hospital Consumer Assessment of Health Providers and Systems survey, and hospital performance on clinical process and outcome measures used in the hospital value based purchasing program; and (b) reexamine the validity of questions used on the HCAHPS survey related to pain management as reliable and accurate measures of the quality of care in this domain.

It also urges CMS to suspend the use of HCAHPS measures addressing pain management until their validity as reliable and accurate measures of quality of care in this domain has been determined (BOT Rep. 9, A-13).

2) FDA to Extend Regulatory Jurisdiction Over All Non-Pharmaceutical Nicotine and Tobacco Products (as amended, I-14)- This resolution supports the U.S. Food and Drug Administration’s (FDA) proposed rule that would implement its deeming authority allowing the agency to extend FDA regulation of tobacco products to pipes, cigars, hookahs, e-cigarettes and other non-pharmaceutical tobacco/nicotine products not currently covered by the Federal Food, Drug, and Cosmetic Act, as amended by the Family Smoking Prevention and Tobacco Contract Act.

It also supports legislation and/or regulation of electronic cigarettes and all other non-pharmaceutical tobacco/nicotine products that: (a) establishes a minimum legal purchasing age of 18; (b) prohibits use in all places that tobacco cigarette use is prohibited, including in hospitals and other places in which health care is delivered; (c) applies the same marketing and sales restrictions that are applied to tobacco cigarettes, including prohibitions on television advertising, product placement in television and films, and the use of celebrity spokespeople; (d) prohibits product claims of reduced risk or effectiveness as tobacco cessation tools, until such time that credible evidence is available, evaluated, and supported by the FDA; (e) requires the use of secure, child- and tamper-proof packaging and design, and safety labeling on containers of replacement fluids (e-liquids) used in e-cigarettes; (f) establishes manufacturing and product (including e-liquids) standards for identity, strength, purity, packaging, and labeling with instructions and contraindications for use; (g) requires transparency and disclosure concerning product design, contents, and emissions; and (h) prohibits the use of characterizing flavors that may enhance the appeal of such products to youth.

3) Electronic Cigarettes, Vaping and Health: 2014 Update –This resolution urges physicians to educate themselves about e-cigarettes, prepare to counsel patients about the use of these products and the potential for nicotine addiction and the potential hazards of dual use with conventional cigarettes, and be sensitive to the possibility that when patients ask about e-cigarettes, they may be asking for help to quit smoking.

The resolution also supports expanding clinical interviews to inquire about “vaping” or the use of e-cigarettes; promotes the use of FDA-approved smoking cessation tools and resources for their patients and caregivers; supports advising patients who use e-cigarettes to take measures to assure the safety of children in the home who could be exposed to risks of nicotine overdose via ingestion of replacement e-cigarette liquid that is capped or stored improperly; and encourages further clinical and epidemiological research on e-cigarettes.

4) D-xxx.xxx Cannabis – Expanded AMA Advocacy- The AMA will educate the media and legislators as to the health effects of cannabis use as elucidated in CSAPH Reports I-13 and A-09 and as additional scientific evidence becomes available.

The resolution will also urge legislatures to delay initiating full legalization of any cannabis product until further research is completed on the public health, medical, economic and social consequences of cannabis use and, instead, support the expansion of such research; will increase its efforts to educate the press, legislators and the public regarding its policy position that stresses a “public health”, as contrasted with a “criminal,” approach to cannabis; and should encourage model legislation that would require placing the following warning on all cannabis products not approved by the U.S. Food and Drug Administration: “Marijuana has a high potential for abuse. It has no scientifically proven, currently accepted medical use for preventing or treating any disease process in the United States.” (New HOD policy)

The AMA’s annual HOD meeting is scheduled for June 6-10, 2015. During this meeting, Dr. Gitlow will be running as a candidate for a seat on the AMA Board of Trustees. Here is the full list of candidates.