FDA commissioner Scott Gottlieb wants doctors to learn in-depth about prescribing opioids. It may seem like a no-brainer, and a lot of addiction advocates have wondered why few doctors learn adequate pain management techniques in med school.
When it comes to prescribing medications, doctors often look for the most obvious problems with the drugs as they’re recommending. For example, a person who is allergic to certain medications, such as the antibiotic Bactrim, may have trouble with other meds in the Sulfa class as well. Some people with autoimmune diseases may have issues with certain medications, too. But most of these reactions don’t transpire with opioid medications.
So it would make sense that doctors take a class on opioid pain medications to understand the implications of prescribing certain pain medications. Doctors are taught about pain medications and how to use them. In fact, many drug manufacturers teach doctors about the benefits of opioids, but there’s little education on adverse side effects, including dependence.
The FDA wants medical schools to add mandatory opioid training to the curriculum, with updates throughout their careers. The classes would teach the dangers of opioid abuse, how to recognize signs of dependence and addiction, and explain alternative pain management including drugs.
Why Are So Many Opioids Prescribed, Anyway?
The FDA knows that in the past, only really the opioid manufacturers have been providing “education”, with much of that under the guise of helping doctors. However, most bad side effects, including addiction, were glossed over or unmentioned in these “education” sessions. In fact, in the case of Perdue Pharma, the makers of Oxycontin, the seminars and other educational meetings held for doctors were just meant to promote the use of opioid drugs. In essence, the manufacturers did a great job over the years of pushing opioids as a necessary solution to all types of pain, even though there are many options to treat pain medically.
In Congress, several bills have been introduced to support the development and FDA approval of non-opioid pain medication, but the truth is that for many people, that’s not necessary. There are actually over 200 non-opioid medications that can treat a specific type of pain. For some people, gabapentin, developed initially as a seizure medication, can treat neuropathic pain. People who have physical injuries or diseases like MS can benefit from medications outside the opioid class.
Other types of nontraditional treatment, such as acupuncture, yoga, or deep breathing can also help people deal with acute bouts of pain.
Why do so few doctors recommend non-opioid pain treatments to patients? For the most part, they are not educated on things that weren’t covered in medical school, and they’re very busy most of the time, so they’re not huge readers. This is why continuing education once a doctor is licensed to practice would also be a good way for the government to make pain treatment education mandatory.
Indiana’s Solution Could Be a Model for Elsewhere
In Indiana, state law requires prescribers to receive opioid prescription training every two years. The State Medical Association and the Richard M. Fairbanks Foundation recently announced they would be funding the statewide program to teach physicians best practices for prescribing opioids.
Some of the money will be used to develop an app to help them do this, giving doctors the ability to learn on-the-go. Other educational material will be podcasts, giving doctors the latest information on best practices in opioid prescribing.
The Future of Pain Management
Hopefully, with the FDA’s continued nudging, the American Medical Association and other physician organizations can start to plot a standard that can work for board-certified doctors to get this type of pain management training wherever they’re located.