AAFP Maintains Mandatory CME to Prescribe Opioids Is Unnecessary

There is a growing health crisis in the United States that affects more than 100 million adults. In fact, according to Institute of Medicine data, chronic pain is costing our country at least $560 billion a year in direct medical costs and lost productivity. At the same time, the number of unintentional overdose deaths associated with medications intended to treat pain nearly doubled from 2002 to 2006, according to the U.S. Department of Justice.

The White House recently announced a multifaceted strategy (11-page PDF; About PDFs) to curb what it is calling an "epidemic" of prescription drug abuse. Although there are portions of the White House plan (e.g., enhanced monitoring, surveillance and enforcement efforts) that deserve our support, there is one aspect that we cannot accept: the call for mandatory CME for health care professionals who prescribe controlled substances.

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.

Nearly 600,000 Americans used OxyContin for nonmedical reasons for the first time in 2008, according to a 2009 survey by the Substance Abuse and Mental Health Services Administration, or SAMHSA. More than half of new users surveyed said they received the drugs from a friend or relative without buying or stealing them.

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.

The AAFP recently adopted a policy that supports the expansion of monitoring and tracking programs and opposes legislation or executive action that would require mandatory education as a condition for prescribing certain drugs. And, the Academy already had a policy in place opposing any actions that limit patient access to prescribed medications and any industry or regulatory action that would have the effect of limiting the use of any pharmaceutical product by specialty.

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 (8-page Word file; About Downloading) 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.