Dr. Katzman would like to see many components of the current REMS program continued, including having physicians educate patients about drugs with associated risks. “They should determine if the risks outweigh the benefits,” Dr. Katzman said.
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June 2016Dr. Katzman recommends that FDA-mandated training be modeled after a program adopted by the New Mexico state legislature in 2012. Initially, it required clinicians to take five hours of training in pain management and screening for addictions within 18 months. Then, whenever a healthcare provider renews his or her medical license, they must complete another five hours of opioid education. “The bill was passed because New Mexico has led the country in the number of overdose deaths, due to both prescription opioids and heroin,” Dr. Katzman said. “We viewed this as a public health crisis.”
“Our model has had positive effects in terms of dispensing fewer long-acting, high-dose opioids (the most dangerous opioids) and benzodiazepines (which are very dangerous when combined with opioids) and on overdose deaths,” said Dr. Katzman, who reports that the University of New Mexico studied the outcomes of the legislation and published them in the American Journal of Public Health in 2014.
According to the study, the bill resulted in a 16% reduction in opioid dispensing, especially high-dose opioids, and a 13% reduction in benzodiazepine dispensing. During the two years following the training, the number of deaths caused by opioid overdoses decreased; only in 2014 did an increase in total drug overdose deaths occur. One hundred of them (the majority) were due to methamphetamine abuse, not opioids (Am J Public Health. 2014;104:1356-1362). “The numbers have remained fairly stable, so we think the education is working,” Dr. Katzman said. “Furthermore, we saw a significant improvement in clinician knowledge, confidence, and attitudes from before taking the course compared with afterward.”
“Opioid misuse and abuse is a huge issue,” added Dr. Winterstein. “It will require a multi-modal approach to get it under control. I support mandatory training because a lot of evidence about pain management has developed over the last few years that prescribers may not be aware of. I think the training will raise awareness of its complexity and ensure that everyone is apprised of current best practices for pain management.”
Karen Appold is a freelance medical writer based in Pennsylvania.
Recognizing Drug Addition or Abuse in Patients
A physician can gather a great deal of information by asking a patient a lot of questions. “By talking to a patient and finding out about their psycho-social history, including whether or not they have a history of addiction, depression, or anxiety, as well as a family history of substance abuse, a clinician may be able to determine if a patient is a suspect for drug addiction or abuse,” said Dr. Katzman.