AAFP Balances Critical Need for Effective Pain Management, Realities of Opioid Abuse

Academy Position Paper Opposes Mandated CME, Other Barriers for Prescribers

August 02, 2012 06:05 pm News Staff
[Stylized photographic image of patient holding head in pain]

In a recently released paper, the AAFP has made it clear that the Academy opposes mandated CME as a prerequisite to DEA registration or licensure to prescribe opioid analgesics.

In an Aug. 1 position paper, "Pain Management and Opioid Abuse(15 page PDF)," the Academy states that mandated CME could limit patient access to legitimate pain management needs. "Family physicians and other primary care clinicians play a vital role in effective pain management, including the prescribing of opioid analgesics. The creation of additional prescribing barriers for primary care physicians would limit patient access when there is a legitimate need for pain relief," the Academy said in a related news release.

Story Highlights

  • The AAFP has issued a formal position paper on opioid abuse and pain management, opposing mandated CME and any other barriers to family physicians' ability to prescribe these drugs.
  • The Academy outlined other points in the paper, including its view that the primary goal of pain management is to improve and maintain function.
  • Regarding a recently approved FDA risk evaluation and mitigation strategy for extended-release and long-acting opioids, the AAFP said it will continue to work with the FDA and others to "ensure policies are in place to allow effective and safe opioid prescribing by family physicians for patients in their pain management programs."

"As such, the AAFP opposes any action that limits patients' access to physician-prescribed pharmaceuticals, and opposes any actions by pharmaceutical companies, public or private health insurers, legislation, the FDA or any other agency, which may have the effect of limiting by specialty the use of any pharmaceutical product."

These statements reiterate two existing AAFP policies, one of which opposes any action limiting patient access to physician-prescribed pharmaceuticals, and the other of which "opposes legislation or executive action that would require mandatory education of family physicians as a condition for prescribing specific drugs, such as opioids."

The Academy outlined several other major points in the paper, including its view that the chief goal of pain management should be to improve and maintain patients' ability to function. The AAFP also urged family physicians to individualize therapy based on review of the potential risks and benefits to each patient, possible drug side effects, and a functional assessment of the patient, and to monitor ongoing therapy accordingly.

In addition, the Academy:

  • supports development of evidence-based physician education to ensure the safest and most effective use of long-acting and extended-release opioids and to reduce the problem of opioid abuse;
  • urges all states to obtain physician input when considering pain management regulation and legislation, as well as implement prescription drug monitoring programs and the interstate exchange of registry information as called for under the National All Schedules Prescription Electronic Reporting(www.nasper.org) (NASPER) Act of 2005; and
  • strongly advocates increased national funding to support research into evidence-based strategies for optimal pain management and incorporation of those strategies into the patient-centered medical home model.
Annals of Family Medicine Focuses on Opioids, Pain Care

The July/August issue(www.annfammed.org) of the Annals of Family Medicine covers numerous topics related to opioids and their role in managing patients' pain.

Articles in the issue sketch out the proper role of prescription painkillers, outline data that indicate depressed patients are more likely to misuse opioids, and discuss the role primary care physicians should play in setting prescribing standards, as well as whether these drugs are an appropriate therapy for primary care patients.

Many states already are working to control the problem of opioid misuse by, for example, adopting model medical board prescribing policies, instituting prescription monitoring programs and developing guidelines about documentation requirements.