By David Pittman, Washington Correspondent, MedPage Today
Published: October 01, 2012
WASHINGTON -- The White House has launched another salvo in its war on prescription drug abuse and diversion: training videos for physicians.
The Office of National Drug Control Policy (ONDCP) on Monday released two online modules it developed to provide clinicians with training material and video vignettes modeling doctor-patient conversations on the safe use of opioid analgesics for pain.
Lack of training in prescribing such medication is a barrier to reducing medication abuse, ONDCP Director Gil Kerlikowske said at a press conference Monday morning. Opioid analgesics were implicated in more than 15,000 overdose deaths in 2009, according to the CDC -- four times the number they were involved in a decade prior.
The modules contain lessons for providers on various topics, including:
- Educating patients on the drugs' risks
- Screening patients for risk factors to identify those a greater risk for abuse
- Discarding unused medicine safely
- Spotting patients who may be forming an addiction
"The videos show the way that the physicians interact with these patients, asking them questions that are sensitive and many physicians feel uncomfortable asking," said Nora Volkow, MD, director of the National Institute on Drug Abuse. "Those that are viewing the videos, by seeing the examples, will feel more comfortable so that when they are faced with that situation they can use what they've learned."
One video is a woman visiting a primary care doctor after receiving opioids from an emergency department for an ankle injury. The physician monitors the pain and discontinues medication when it is no longer needed.
The other video is of a middle-age man taking opioids for chronic back pain, whom the physician suspects may be abusing the drugs.
Providers can receive 1.25 CME credits per module and each takes about an hour to complete, Volkow said.
More than 5,000 physicians already have taken the online training. "It is quite impressive, but I think it also highlights the sense that there's a need for training materials that clinicians can use that can help guide them to screen their patients who are being treated with opioid medication for the management of pain," Volkow said.
Providers provide an important line of defense in stopping prescription drug abuse, Kerlikowske said.
"Too often I hear from the medical community that there are very few hours in medical school devoted to safe and effective pain management," Kerlikowske said. "Unfortunately, this lack of training can lead to improper prescribing of powerful painkillers and a lack of understanding about the disease of addiction and how it can be prevented and treated."
Kerlikowske called on professional medical societies to let their membership know of the online modules.
"We still believe that training in proper opioid prescribing should be a prerequisite for anyone who prescribes certain types of prescription drugs," Kerlikowske said.
Last week, the White House released a report showing prescription drug abuse was down among 18- to 25-year-olds 14 percent from 2011 to 2010. However, that same report showed heroin use was up.
When asked Monday if prescription drug abusers were simply shifting from one substance to another, Volkow said physicians and policymakers need to focus on the abuse of opioid prescriptions.
"If you can mount a very aggressive prevention strategy to avoid the abuse of prescription medication, then you will not have that transition into injection use of heroin," Volkow said. Patients become addicted to opioids and then shift to less-expensive heroin to feed their addition, she said.
The White House's plan to cut prescription drug diversion and abuse, released last year, calls on supporting provider education, expanding state-based monitoring programs, and reducing the prevalence of "pill mills" and doctor-shopping through enforcement actions.
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