Despite startling statistics on the abuse of prescription opioids and the rising number of overdose deaths, physicians still don’t get enough training on how to properly prescribe these drugs, according to federal health officials.
Ramping up education of prescribers is one of the federal government’s main strategies for combating opioid addiction, health officials told lawmakers during a hearing of the House Energy and Commerce Committee on April 29. Lawmakers convened the hearing to discuss concerns about continued prescription opioid abuse and reports that some people are transitioning from prescription opioids to heroin.
About 100 Americans died from a drug overdose each day in 2010, according to the Centers for Disease Control and Prevention. Overall, there were more than 38,300 overdose deaths in 2010, with prescription opioids involved in more than 16,600 and heroin involved in about 3,000. Deaths from drug overdose in the United States now eclipse those from gunshot wounds and car crashes, according to the CDC.
Along with prescriber education, federal agencies are also expanding state-based prescription drug monitoring programs, providing more ways for people to safely dispose of unused prescription drugs, and shutting down pill mills and discouraging doctor shopping, said Michael Botticelli, acting director of the Office of National Drug Control Policy.
Federal agencies also are expanding access to substance abuse treatment and trying to get the word out about emergency overdose reversal medications like naloxone (Narcan).
"It is clear we cannot arrest our way out of the drug problem," Mr. Botticelli said.
One problem is that physicians are both undertreating chronic pain and overprescribing opioids, said Dr. Nora D. Volkow, director of the National Institute on Drug Abuse. There’s room for improvement when it comes to educating prescribers, she said. For instance, education efforts need to include not only which types of patients are appropriate for opioids, but how many pills they should get.
Several states, including Iowa, Kentucky, Massachusetts, Ohio, Tennessee, and Utah, have passed legislation mandating prescriber education. Mr. Botticelli said his agency is encouraging other states to do the same.
One tool that can be used by physicians, patients, and first responders is a free opioid overdose prevention toolkit from the Substance Abuse and Mental Health Services Administration (SAMHSA). The toolkit, originally released last year, takes physicians step by step through evaluating new patients, selecting an appropriate therapy, executing the prescription order, monitoring the patient’s response to treatment, and deciding when to end opioid therapy. It also provides tips on when to prescribe naloxone – an opioid antagonist– with the initial opioid prescription.
For instance, SAMHSA cautions physicians to take special care in evaluating new patients. In addition to a standard history and examination, SAMHSA officials recommend finding out who last treated the patient, what medications were previously prescribed, and what substances (including alcohol) that patient has used.
Even if an opioid analgesic is appropriate, the amount still should be limited. Physicians should prescribe only enough to meet the patient’s needs until the next appointment.
mschneider@frontlinemedcom.com
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