Mandatory prescriber education among immediate steps recommended by Trump's opioid commission

Hydrocodone opioid pills
A presidential commission made recommendations to reverse the country's opioid crisis.

The president’s opioid commission released an interim report yesterday that called on President Donald Trump to declare a national emergency and outlined immediate steps to reverse the country’s opioid epidemic, including mandated prescriber education.

One doctor involved in educating physicians about opioids welcomed the call for more training.

“I think it’s great,” said Gregory Makris, M.D., medical director for the Altarum Center for Appropriate Care, headquartered in Ann Arbor, Michigan, in an interview with FierceHealthcare. “It’s how it’s carried out that is going to make the difference.”

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The bipartisan President’s Commission on Combating Drug Addiction and the Opioid Crisis, formed by executive order of the president and chaired by New Jersey Gov. Chris Christie, released a laundry list of recommendations in an interim report (PDF) now headed to Trump’s desk.

“With approximately 142 Americans dying every day, America is enduring a death toll equivalent to September 11th every three weeks,” Christie said, as the commission met to approve the report.

The report called for the president to mandate education in opioid prescribing and on the risks of patients developing a substance use disorder by requiring all Drug Enforcement Administration registrants to take a course in the proper treatment of pain.

Four out of five heroin users begin with the use of prescription opioid painkillers, Christie said.

“This crisis began in our nation’s healthcare system. While we acknowledge that some of this inappropriate overprescribing is done illegally and for profit, we believe the overwhelming percentage is due to a lack of education on these issues in our nation’s medical and dental schools and a dearth of continuing medical education for practicing clinicians,” the commission report said.

Commission member Bertha Madras, Ph.D, said the opioid crisis cannot be solved without the involvement of the medical community and will require an evolution, if not a revolution. If physicians are not trained, patients will fall through the cracks and not receive treatment for substance abuse, she added.

The report’s release came on the same day as the funeral of an Indiana doctor who was killed for refusing to prescribe opioids.

Todd Graham, M.D., was gunned down last Wednesday by an Indiana man who then killed himself. Authorities have said that the man confronted the doctor for not prescribing an opioid for his wife’s chronic pain during an office visit that morning.

Law enforcement officials are still trying to determine if drug addiction on the part of the man or his wife played a role in the killing, according to a Washington Post report.

A doctor’s perspective

Makris has helped develop a six-month doctor education program, a partnership between Altarum and the University of Michigan Medical School and Health System. The just-launched program is different from the typical one-hour continuing education programs in that it provides physicians and practices with six months of follow-up, he said.

The program includes support tools for physicians to help improve responsible opioid prescribing and patient education. Doctors learn what to do when they assess a patient at risk for a substance use problem and are made aware of possible treatment options. The follow-up, beyond an initial class, is key to lasting change in prescriber habits, Makris said.

RELATED: White House opioid commission calls for data sharing between state and federal PDMPs by next year

Other recommendations

The opioid commission will release a final report this fall, but Christie said the group wanted to get its initial recommendations to President Trump. Other recommendations include:

  • Rapidly increase treatment capacity for patients with substance use disorders by granting waivers in all 50 states to eliminate barriers resulting from a federal exclusion that prohibits Medicaid reimbursement for mental health services provided in inpatient facilities that have more than 16 beds. That action will immediately open treatment to thousands of Americans in existing facilities. 
  • Immediately establish and fund a federal incentive to enhance access to medication-assisted treatment.
  • Provide model legislation for states to allow naloxone dispensing via standing orders, as well as requiring the prescribing of naloxone with high-risk opioid prescriptions. The commission also wants to see all law enforcement agencies equipped with life-saving naloxone, which can reverse the effects of an overdose.
  • Prioritize funding and manpower to federal agencies to quickly develop and disseminate fentanyl detection sensors to staunch the flow of deadly synthetic opioids.
  • Provide federal funding and technical support to states to enhance interstate data sharing among state-based prescription drug monitoring programs.
  • Better align, through regulation, patient privacy laws that would soften HIPAA regulations when patients overdose.
  • Enforce the Mental Health Parity and Addiction Equity Act to ensure health plans cannot impose less favorable benefits for mental health and substance use diagnoses verses physical health diagnoses.