Prescription drug abuse epidemic demands mandatory physician education

Our nation’s growing concern and response to the epidemic of opioid misuse and abuse continues to drive action from public health and public policy leaders. Attorney General Eric HolderEric H. HolderEric Holder to headline fundraiser for Clinton The Hill's 12:30 Report The Hill's 12:30 Report MORE recently announced a new regulation to greatly expand the drug-take-back program to make it easier to return unused prescription drugs and controlled substances.  New DEA rules for the safe and secure disposal of prescription drugs take effect in October.  And public health officials from three of the largest metropolitan health departments this week briefed Capitol Hill on their front-line efforts to battle opioid abuse. 

Yet as FDA Commissioner Margaret Hamburg rightly reminds us: meaningful actions on the epidemic must be taken within the context of a comprehensive solution to the problem – one that recognizes the legitimate treatment need for such opioid medications by millions of Americans living with chronic pain.  

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Although expanded take-back and enhanced drug disposal programs are part of the solution to stemming misuse and abuse of these powerful medications, the greatest need now is for better prescriber education. Commissioner Hamburg frequently cites the importance of tackling inappropriate prescribing as central to winning the war against opioid abuse.  She has stated we must improve appropriate prescribing through educational materials required as a part of a risk mitigation strategy for extended-release and long-acting opioids.  

I believe we need to go farther. If we’re serious about curbing opioid misprescribing, misuse and abuse, we need mandatory physician education. Now.  We have learned a great deal in the past decade on what types of patients may benefit, how to prescribe and what goes into the decision to continue prescribing opioids. Education can drive appropriate prescribing, monitoring and patient education and help reduce misuse and abuse. 

But it doesn't make sense for each of the 50 states to develop individual educational programs for appropriate standards for opioid prescribing.  The opioid abuse epidemic is a national problem that is best addressed at the national level. The federal government would provide great service to chronic pain patients, health care providers and individual states by developing a mandatory educational program that can be tied to DEA registration and a national prescription monitoring program.  

Limitations on personal and professional time and a lack of practicality inherent in the many educational programs available have been major barriers to progress. Therefore, any mandatory educational program needs to be practical and accessible. The FDA’s online Extended-Release/Long-Acting Opioid Analgesics Risk Evaluation and Mitigation Strategies (ER/LA REMS) program is a good starting point. 

Although there has been physician resistance against an educational mandate, there is no dispute among prescribers across the spectrum about the need for education. But unfortunately voluntary education has not worked, nor is it expected to. 

Better educated prescribers of opioids will be a welcome complement to needed patient and family education that also should be re-enforced at the health care provider, pharmacy and the pharmaceutical company level.  Each visit to the health care provider’s office and pharmacy is further opportunity for consumer education. 

We know that opioids can play a vital role as an effective part of a balanced, multimodal plan of care that can improve function for selected patients suffering from chronic pain who have not responded to nonopioids. Mandatory prescriber education is key to ensuring these critically important medications are prescribed appropriately and used in ways that FDA intended when they approved them. 

Gharibo is associate professor of Anesthesiology and Pain Medicine and medical director of Pain Medicine at NYU Langone - Hospital for Joint Diseases.

 

 

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