Doctors Caught Between Patient Pain, Prescriptions
"It seems well-intentioned, but if there is going to be legislation telling doctors every time they need to take additional training, there won't be enough hours in the day to take it all," Stream says, referring to the Washington law. Some states are considering fellowship-training requirements that could impact primary care physicians, he says. "We've been concerned about some states whose efforts to control opioid misuse is actually getting in the way of physician treatment."
In Washington State, some primary care physicians have opted out of the pain treatment business instead of complying with state regulations, Stream explains. "They are saying ‘I'm not going to treat (patients for chronic pain)." "(Patients) can find someone else. The trouble is, in rural areas, there isn't someone else. This is a huge concern." Oddly enough, Stream estimates that 40% of chronic pain among patients is not treated.
Federal agencies are also trying to enhance education programs about opioid analgesics. They are becoming mandatory for drug manufacturers, but voluntary for physicians – as of now.
Last month, the Food and Drug Administration released a Risk Evaluation and Mitigation Strategy (REMS) for extended-release and long-active opioid medications. The REMS is part of a multi-agency federal effort to address the growing problem of prescription drug abuse and misuse, with educational programs as a key component.
"Misprescribing, misuse and abuse of extended-release and long-acting opioids are a critical and growing public health challenge," FDA Commissioner Margaret A. Hamburg, MD, said in a statement when the REMS was released. "The FDA's goal with this REMS approval is to ensure that health care professionals are educated on how to safely prescribe opioids, and that patients know how to safely use these drugs."
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