Mandating Physician Education

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In May of this year, Massachusetts Senator Ed Markey proposed a new bill titled the Safe Prescribing of Controlled Substances Act. This Act, among other things, calls for mandatory education of the nation’s physicians about, as the name implies, safer prescribing of controlled substances. It also calls for mandatory education about identifying patients with substance use disorders.

Physicians get very little education about this tremendously important problem. Some medical schools and residencies have added addiction trainings, but change happens slowly. Plenty of doctors in the U.S. are still mis-prescibing

Physicians are not going to like this legislation. We hate being told we have to do anything, especially by politicians. But obviously, the present generation of physicians is NOT able to prescribe controlled substances properly, as evidenced by our epidemic of prescription drug addiction.

The bill extends to any prescriber of controlled substances, meaning that physician assistants and nurse practitioners will also be required to take this training, at least in states where they are allowed to prescribe controlled substances.

Senator Markey’s bill says the Department of Health and Human Services is responsible for producing this training and that it will be free and available online.

The bill specifies the training should include, “methods for diagnosing, treating, and
managing a substance use disorder, including the use of medications approved by the Food and Drug Administration and evidence-based non-pharmacological therapies.”

If everyone interprets this paragraph as I do, this would mean all doctors who want to prescribe controlled substances should be educated about medication-assisted treatments of opioid addiction, among other things.

That would be wonderful. How nice it would be for my patients to go to their other doctors, and hear, “So glad you are on methadone for the treatment of addiction. Good job.” instead of the usual insults about being on of MAT. How nice for me to be able to call other doctors who don’t think I’m a drug pusher for prescribing MAT!

Also, Senator Markey sent letters to the VA, Defense Department, and IHS, urging them to included prescribing information to their patients on their state’s prescription monitoring program. Many patients being cared for by these agencies are prescribed controlled substances, but doctors outside those systems have no way to know what is being prescribed. Presently, they don’t report to the prescription monitoring programs. I hope these military agencies chose to participate in the PMPs. It would be a way to keep those patients safer when they seek care outside the military system.

On May 15, 2015, the Huffington Post had an online article about another bill, the Recovery Enhancement for Addiction Treatment Act, also sponsored by Senator Markey and Senator Rand Paul. This legislation would lift the one-hundred patient limit placed on office-based buprenorphine doctors.

In the past, I supported lifting the one-hundred patient cap, but I’ve come to believe the cap isn’t all that relevant, at least in my area. Around here, I think the only physicians who honor the cap are conscientious doctors who would do a good job without legislation.

Around here, physicians have more than one hundred buprenorphine patients, and skirt the regulations by saying some of them are prescribed it “for pain.” Physician extenders without DEA “X” numbers already prescribe buprenorphine in this state. When the North Carolina medical board was notified about this, they declined to take any action.

In other words, the present regulations are flouted without consequence, so lifting them isn’t going to make a big difference. (That may not be the case in all areas of the country.) But mandating education about addiction and its treatment may help treatment providers deliver better care.

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6 responses to this post.

  1. Posted by William Taylor, MD on August 11, 2015 at 7:05 pm

    No argument that physician prescribing could be much better, and that prescribers should have a basic familiarity with addiction precautions and databases.

    However, those of us who mistrust the federal government should be alarmed at the federal expansion of what has been a state responsibility. I just finished my 2 hr course for my SC license, covering just these topics. Once the feds start down the path of mandated physician education, expect requirements to take courses on the virtues of organic broccoli for patients.

    Reply

  2. I’m not sure the NC Board can prevent the off-label prescribing of buprenorphine for pain. TN seems to be taking action that will further limit access to MAT.
    I read your Dec blog about TN limiting prescriber dosing discretion and would like to add that TN is now prohibiting off label use: http://buprenorphine.samhsa.gov/bwns/2010_presentations_pdf/43_Heit_508.pdf
    Another bill, passed by the TN Senate and (likely) to pass the House will require Certificates of Need for all OBOT clinics: https://trackbill.com/bill/TN/109/SB829/hospitals-and-health-care-facilities-as-introduced
    Wonder how that will work out?

    Reply

    • Hi Dan,
      No, my point wasn’t that off-label use is bad or even should be prevented, but rather that I oppose the disingenuous use of a pain diagnosis to get around the 100 patient limit, when the patient does, in fact, have the disease of opioid addiction. In other words, falsifying records in order to get around a regulation so that the doctor can treat more than 100 patients at a time.

      Reply

  3. Posted by kevin on August 18, 2015 at 8:38 am

    Good read and very interesting

    Reply

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