A group representing pain management physicians is calling for mandatory education for doctors who prescribe opioids. The American Society of Interventional Pain Physicians (ASIPP) is advocating for legislation that would require health care professionals who prescribe drugs to receive specialized training. Several such bills are currently circulating in the House and Senate.
Between 80 and 90 percent of doctors in the United States have no formal training in prescribing opioid medications, says David Kloth, MD, a Connecticut-based pain management specialist and spokesperson and former president of ASIPP. “I would never prescribe chemotherapy or heart medication to a patient, because I have no formal training in how to do so. But many doctors who haven’t been properly trained are prescribing opioids.”
Physicians who prescribe opioids must understand a wide range of problems, including addiction and drug-drug interactions, Dr. Kloth notes. He says many primary care doctors prescribe opioids in an effort to help their patients, and often don’t realize the complexity of the issues.
The need for opioid training is multifaceted, Dr. Kloth says. “When you prescribe opioids, you need to be a doctor, detective, parent and policeman all in one.” Education would include drug-drug interactions, safe dosing, how to transition from one medication to another, how to monitor and look for signs of abuse, and how to use one’s state prescription monitoring program.
A critical area of training is drug-drug interactions, Dr. Kloth notes. “Many medications, including antidepressants, can affect the metabolism of opioids, and in some cases can cause fatal overdoses,” he says. “Doctors need to be trained in drug-drug interactions, and in the importance of discussing them with patients.”
In April, the Office of National Drug Control Policy (ONDCP) unveiled its 2011 Prescription Drug Abuse Prevention Plan, which calls for education of physicians who prescribe opioids. The plan requires drug manufacturers, through the Opioid Risk Evaluation and Mitigation Strategy (REMS), to develop educational materials and initiatives to train practitioners on the appropriate use of opioid pain relievers. The REMS physician training would be voluntary; the various pieces of legislation currently under consideration would close that loophole by mandating opioid-related continuing medical education.
For example, the Prescription Drug Abuse Prevention and Treatment Act of 2011, introduced by Sen. Jay Rockefeller (D-W.Va.), would amend the Controlled Substances Act to require prescribers to complete 16 hours of opioid prescribing training every three years. The Ryan Creedon Act, sponsored by Rep. Mary Bono Mack (R-CA), would ensure that health care professionals receive a minimum amount of abuse and addiction education before they are registered with the U.S. Drug Enforcement Administration to prescribe controlled substances.
Rep. Bono Mack acknowledges that while some medical professionals view yet another new training requirement for medical professionals as burdensome, this training is necessary to protect patients. Her act is named after a young man from her district who suffered from a chronic addiction to OxyContin that ultimately resulted in his death. “Today, the abuse of prescription drugs – especially painkillers, stimulants and depressants – is the fastest growing substance abuse problem in America,” said Bono Mack. “This legislation takes the necessary steps to ensure that only doctors who are knowledgeable about the abuse and addiction risks of these powerful medications can prescribe them.”
Who Will Conduct Training?
Dr. Kloth notes that his group is concerned that if drug manufacturers conduct the training it will lead to more inappropriate prescribing. “It’s like the fox watching the hen house; physicians should do the training,” he says, noting that ASIPP has an opioid prescribing course and exam, which it has offered to provide to the government at no cost. “We are open to input from others about the content, but at least we have something that is ready to go,” he adds.
ASIPP believes that physician training for opioid prescribing will likely be overseen by the Department of Health and Human Services and the Food and Drug Administration, and hopes the agencies will work in conjunction with medical societies. One suggestion is for a web-based training program of between eight and 12 hours, with an exam at the end. “If there’s no exam, there’s no guarantee a doctor has really gone through the program,” he says.
Dr. Kloth emphasizes that ASIPP is in no way arguing against the use of pain medication. “What we are advocating for is responsible prescribing,” he says. “We believe these drugs are very important. But if we don’t clean up the problem of opioid abuse, they may not be available for people who really do need them.”