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From the President
AAFP Maintains Mandatory CME to Prescribe Opioids Is Unnecessary
And the White House isn't the only federal entity pursuing mandatory CME. In March, Sen. Jay Rockefeller, D-W.Va., introduced a bill that would amend the Controlled Substances Act and that calls for prescribers to complete 16 hours of mandatory CME related to opioids and pain management every three years.
According to the Obama administration, if this legislation becomes law, physicians would be required to complete the CME to receive or renew their DEA registration, regardless of whether they write prescriptions for long-acting opioids. This approach not only places an undue burden on physicians, it does not address the real and rapidly growing problem of drug diversion.
The Real Problem
At the state level, more than 60 percent of all unintentional, fatal overdoses of controlled prescription drugs in 2006 in West Virginia involved individuals who did not have prescriptions for the drugs that contributed to their deaths.
Clearly, doctors' prescriptions are being diverted every day. According to the Department of Justice, pharmaceutical diversion and abuse is viewed as the greatest drug threat by a growing number of the nation's law enforcement agencies.
Obviously, there is a problem, but that problem exists because of system issues that we, as family physicians, do not control. We can and certainly should tackle issues that we do control, such as pursuing further voluntary education in multiple areas, including pain management. In fact, the Academy has offered nearly 90 CME activities related to pain since June 2009. Fifteen more activities are scheduled during the AAFP Scientific Assembly next month in Orlando, Fla.
In addition, the AAFP has developed a monograph for opioids that is based on guidelines from the American Pain Society and the American Academy of Pain Medicine. This monograph is designed to help you properly treat patients with chronic pain.
Clearly, significant voluntary educational opportunities regarding appropriate prescribing of pain medicines already exist. Requiring more will not solve the problem of drug diversion. However, there are measures that could more effectively address opioid abuse. For example, only a small number of physicians are the bad actors in this situation. They should be dealt with appropriately by licensing boards. In addition, every state should have an effective tracking system capable of identifying its most significant abusers.
In addition, during the past two years, the AAFP's elected leaders, commission members and staff have met repeatedly with representatives of various federal agencies, including the FDA, the White House Office of National Drug Control Policy, the Health Resources and Services Administration, and SAMHSA. During those meetings, the AAFP's representatives have made it clear to federal officials that the Academy and its members do not support mandatory CME. They also pointed out that the AAFP already offers its members CME opportunities related to pain management throughout the year.
More than two years ago, the AAFP signed on to an AMA letter to the FDA that rejected the idea of mandatory education. That letter made the point that such heavy-handed action could lead to physicians opting out of prescribing Schedule II controlled substances, reduced access for patients with a legitimate need for the medications and a shift to prescribing Schedule III opioid products.
Rather than force mandatory CME on prescribers, the AAFP supports voluntary education. Academy staff members have been collaborating with other CME accreditors, and pharmaceutical industry representatives on an FDA initiative to develop a voluntary Risk Evaluation and Mitigation Strategy program, which would provide free, accredited CME to prescribers of opioids.
It certainly behooves us to be as knowledgeable as possible about the many conditions we treat as family physicians, but mandated education that doesn't address the root problem of prescription drug abuse simply doesn't make sense. The AAFP will continue to work to preserve family physicians' ability to care for patients in all areas, including pain management.