Rockefeller Bill Linking Education, Physician Prescribing Redundant, Says AAFP

A bill introduced by Sen. John Rockefeller, D-W.Va., that would require physicians to undergo mandatory education as a condition for prescribing certain drugs, such as opioids, has triggered a letter protesting the language in the bill and outlining the extensive education family physicians undergo that makes them fully qualified to prescribe opioids without resorting to mandatory education.

In the September letter to Rockefeller, AAFP Board Chair Roland Goertz, M.D., M.B.A., of Waco, Texas, cites AAFP policy, which opposes legislation or other actions that would require mandatory education of family physicians as a condition for prescribing specific drugs, including opioids.

The policy, which was approved by the AAFP Board chair in August, also supports "programs that would provide funding to all states to monitor 'real-time' opioid prescribing and to also make this information available across state lines as one way to address the public health problem of prescription drug abuse."

In the letter to Rockefeller, Goertz points out that "following medical school, family physicians complete a three-year residency program that includes training in all medical specialties and drug prescribing. In addition, to remain members of the AAFP, family physicians are required to complete 150 credits of continuing medical education, or CME, every three years. In particular, the AAFP has offered nearly 90 CME activities related to pain since June 2009."

In addition, the AAFP offered 15 supplementary activities during the AAFP Scientific Assembly last month in Orlando, Fla. The Academy also has developed a monograph on opioids, based on guidelines from the American Pain Society and the American Academy of Pain Medicine, that is designed to help AAFP members properly treat patients with chronic pain, according to Goertz.

There are two main components of the ongoing public health crisis caused by the unlawful prescribing of opioids and other drugs, says Goertz: drug diversion, which requires educating the public regarding prevention, and misuse of patient medications due to inappropriate prescribing by a physician or misuse by a patient.

Goertz points out that significant voluntary educational opportunities already exist on how to appropriately prescribe pain medications. "The AAFP does not believe that requiring additional education (for family physicians) will solve the problem of drug diversion." But, he adds, there are measures that could more effectively address opioids abuse. "For example, only a small number of physicians are the 'bad actors' in this situation. The AAFP believes licensing boards should deal with them appropriately. In addition, every state should have an effective tracking system capable of identifying its most significant abusers."

In addition, legislation requiring mandatory education would put further administrative burdens on already overextended family physicians, says Goertz. "Our particular concern is that some family physicians would not be able to take the time away from their practice for this extra training and, thus, would not be able to undergo the training and receive a drug enforcement administration number. …The unintended consequence could be a decline in access to these drugs for patients who need them. Clearly, this is not our goal, nor is that the goal of the legislation."

Goertz does note, however, that the AAFP supports provision in the bill that relate to the National All Schedules Prescription Reporting, or NASPER, Act. "These provisions would increase NASPER's funding to assist states in development of programs to monitor and share across borders information on opioid prescribing," says Goertz. "The AAFP realizes that there are patients with inappropriate drug-seeking behavior. However, it is not always clear who these individuals are absent a database containing this information."