AAFP POSITION PAPER OPPOSES MANDATED CME, OTHER BARRIERS FOR PRESCRIBERS OF OPIOIDS

doi:10.1370/afm.1437

In a position paper dated August 1, 2012, “Pain Management and Opioid Abuse,” the American Academy of Family Medicine (AAFP) states that mandated CME could limit patient access to legitimate pain management needs. “Family physicians and other primary care clinicians play a vital role in effective pain management, including the prescribing of opioid analgesics. The creation of additional prescribing barriers for primary care physicians would limit patient access when there is a legitimate need for pain relief,” the Academy said in a related news release.

“As such, the AAFP opposes any action that limits patients’ access to physician-prescribed pharmaceuticals, and opposes any actions by pharmaceutical companies, public or private health insurers, legislation, the FDA or any other agency, which may have the effect of limiting by specialty the use of any pharmaceutical product.”

These statements reiterate 2 existing AAFP policies, one of which opposes any action limiting patient access to physician-prescribed pharmaceuticals, and the other of which “opposes legislation or executive action that would require mandatory education of family physicians as a condition for prescribing specific drugs, such as opioids.”

The Academy outlined several other major points in the paper, including its view that the chief goal of pain management should be to improve and maintain patients’ ability to function. The AAFP also urged family physicians to individualize therapy based on review of the potential risks and benefits to each patient, possible drug side effects, and a functional assessment of the patient, and to monitor ongoing therapy accordingly.

In addition, the Academy:

supports development of evidence-based physician education to ensure the safest and most effective use of long-acting and extended-release opioids and to reduce the problem of opioid abuse
urges all states to obtain physician input when considering pain management regulation and legislation, as well as implement prescription drug monitoring programs and the interstate exchange of registry information as called for under the National All Schedules Prescription Electronic Reporting (NASPER) Act of 2005
strongly advocates increased national funding to support research into evidence-based strategies for optimal pain management and incorporation of those strategies into the patient-centered medical home model

According to the AAFP, 37 out of 50 states have implemented, or are in the process of implementing, prescription drug monitoring programs that use NASPER grant funding. In addition, various professional organizations either have or are developing prescribing guidelines for physicians treating patients with chronic noncancer pain.

In the position paper, the Academy also cited the FDA’s recently issued risk evaluation and mitigation strategy for extended-release and long-acting opioids, saying it will continue to work with the FDA and others on projects such as the FDA’s Safe Use Initiative to “ensure policies are in place to allow effective and safe opioid prescribing by family physicians for patients in their pain management programs.”

Many states already are working to control the problem of opioid misuse by, for example, adopting model medical board prescribing policies, instituting prescription monitoring programs, and developing guidelines about documentation requirements.