Resolving the nation's opioid abuse and misuse epidemic demands a multipronged approach that draws on expertise from both the public and private sectors, the AAFP recently told HHS. Only through the combined efforts of the medical, education, public health, judicial and pharmacy communities, as well as those of policymakers at all levels, can the "scourge of opioid abuse and addiction" be overcome.
So said AAFP Board Chair Robert Wergin, M.D., of Milford, Neb., in a Sept. 2 letter(3 page PDF) to Kathryn Martin, acting assistant secretary for planning and evaluation at HHS' Office for Civil Rights, in which the Academy responded to a request for information(www.federalregister.gov) about prescriber education and training to prevent opioid overdose and opioid use disorder.
- Resolving the nation's opioid abuse and misuse epidemic demands a multipronged approach that draws on expertise from both the public and private sectors, the AAFP recently told HHS.
- In response to the agency's request for information, the Academy detailed its success in providing pain management and opioid-related CME to its members.
- The AAFP also reiterated its opposition to mandatory CME on this topic and denounced any actions that would limit family physicians' ability to prescribe these drugs.
Specifically, HHS is seeking comments on a range of approaches used to educate and train clinicians about pain management and appropriate opioid analgesic prescribing, including identifying patients at risk for abuse and prescribing the appropriate dose and quantity of medication for their condition. In addition to requesting feedback on its own programs to engage prescribers on these topics, the agency also wants to assess the impact of other training policies and programs on opioid analgesic prescriber proficiency.
As an organization laser-focused on protecting the health of the public, "We are deeply aware of the critical and devastating problem of prescription drug abuse and the resulting deaths," Wergin stated in his letter.
"At the same time," he added, "we must provide patients with adequate pain management. Chronic pain is a serious health issue with tremendous economic, social and medical costs."
Support for PDMPs, CME
Wergin noted the AAFP's support for state prescription drug monitoring programs (PDMPs) that facilitate the interstate exchange of registry information about patients' prescription medication use. And he agreed that physicians should always consult their state PDMP before prescribing medications that have the potential for abuse.
"However," Wergin stated, "the success of such efforts depends on state reporting systems that are accessible, timely and interoperable. We must to work together to make these systems effective for the sake of the public health."
Wergin went on to address the FDA's creation of a Risk Evaluation and Mitigation Strategy for long-acting and extended-release (LA/ER) opioids, which requires pharmaceutical companies that market opioid analgesic products to pay for the development of educational programs for prescribers on appropriate use of these products. Although the Academy recognizes the need for evidence‐based physician education to ensure safe and effective use of LA/ER opioids, mandating CME for individual prescribers "is not the solution for this public health crisis," he stressed.
Family physicians already are deeply committed to fine-tuning their ability to prescribe opioids appropriately, Wergin pointed out, as witnessed by the fact that AAFP members reported completing well more than 133,000 CME credits on this topic in 2014. And that was before the AAFP signed on to a number of related initiatives, including efforts by the White House, HHS and other federal agencies to tackle the opioid crisis, in addition to its work with the AMA Task Force to Reduce Opioid Abuse.
Most recently, the Academy joined with U.S. Surgeon General Vivek Murthy, M.D., M.B.A., in his Turn the Tide Rx campaign to end opioid abuse.
As further proof of its commitment to appropriately addressing the pain management and opioid-related educational needs of physicians, the AAFP signed on to a letter from the Conjoint Committee on Continuing Education (CCCE) that also responded to HHS' RFI. The CCCE is a national coalition of 26 organizations that represent the fields of medicine, nursing, dentistry and pharmacy, including nurse practitioners and physician assistants.
A convened group of the Council of Medical Specialty Societies, the committee's self-professed goal is "to use the continuing education of health professionals to improve aspects of the performance of the U.S. health care system," said the group in its letter. In this instance, "The CCCE's strategic focus is to voluntarily educate prescribers of long-acting opioid analgesics and their practice teams" about the FDA's risk evaluation and mitigation strategy (REMS) requirements.
The Sept. 6 letter then describes the committee's REMS-related educational activities to date, including focused efforts to educate practice teams, and lays out challenges encountered in delivering this education to clinicians -- most notably, practice burden.
The letter concludes with calls to treat REMS-related continuing education as an ongoing quality improvement activity and to align the efforts of the various federal agencies involved in tackling the opioid abuse epidemic to maximize the effects of their combined actions.
The AAFP has gone on record as opposing limiting patients' access to any physician-prescribed pharmaceutical without cause, Wergin stated, as well as any actions that may have the effect of limiting physicians' ability to prescribe such products by specialty.
At the same time, he added, family physicians have long advocated expanding the use of buprenorphine in medication-assisted treatment for opioid addiction and so were pleased by the Substance Abuse and Mental Health Services Administration's recent announcement that it was increasing the number of patients qualified physicians are able to treat with the drug to 275.
Still, further policy changes are needed, said Wergin, if this public health crisis is to be resolved. "It will require an all-hands-on-deck effort by the entire health care community, as well as national and state policymakers."