Another day, another story in the news about the opioid epidemic that is transcending America. Local, state, and national elected officials are speaking out about it, as are physicians and patient advocates.
Sometimes in life, we are put in a fortunate position to take the lead and to have a life-changing effect on strangers. One of the ways we may be able to turn this epidemic around is to continue to educate all parties involved – from the patient, to the caregiver, and yes, even the physician prescribing the medication.
When President Donald Trump declared opioids a national public health emergency, he stated, “Last year, almost 1 million Americans used heroin, and more than 11 million abused prescription opioids. The United States is by far the largest consumer of these drugs, using more opioid pills per person than any other country by far in the world.” Often, the addiction begins with a legal prescription for a patient suffering from debilitating pain.
Stakeholders who participated in a POLITICO working group seemed to agree that the CDC guidelines on safe prescribing (a voluntary tool) had catalyzed change in managing chronic pain, and created a general heightened awareness about using smaller doses for briefer periods for acute pain. While working group participants differed on how much impact the guidelines had, all viewed them in a positive light.
Educate Providers at the Beginning of Their Career
We sometimes hear that med school does not fully equip one to be a practicing doctor, and one piece of that is understanding responsible practices for prescribing medications.
While med schools in the United States have “been very active” incorporating training on pain management, as well as addiction and dependence (which aren’t interchangeable), there is still more than can be done.
However, even if the med schools get it right, participants noted how easily training can go out the window if new physicians are practicing in a setting where opioids are prescribed more indiscriminately than the way they were taught to prescribe. This is where continuing medical education (CME) can come in to play a large role.
Is This a Place for CME?
As noted by one participant, “You can teach all you want in medical school but once they get into the clinical environment, if that clinical environment hasn’t changed, then you’re undermining all those lessons.”
Ongoing professional education can take place through formal continuing medical education or within health care systems. For example, one participant recounted a program in which physicians in a health system received feedback on their prescribing patterns — and were told how they stacked up against colleagues. Competitive instinct and “peer accountability” reduced opioid prescribing, said that participant.
Prescribing is only one piece of the puzzle. Most participants said doctors and nurses don’t know enough about addiction — how to spot it, treat it or connect a patient to resources and supports. This is another avenue for CME to enter the picture to help our physicians and patients alike.
Therefore, POLITICO and the stakeholders made a policy recommendation focused on educating providers. They suggest that education on both pain management and addiction has to start in medical school. However, early education is not enough unless it is supplemented by CME. The medical field should continue the progress it has made increasing education around proper prescribing, but it should increase its efforts by evaluating doctors in some meaningful way such as on licensing exams or through CME.