<p>An Examination of State and Federal Opioid Analgesic and Continuing Education Policies: 2016–2018</p>

Abstract

Introduction: Opioid overdose deaths in the United States have climbed sharply over the past two decades. Simultaneously, increased awareness of inadequately treated chronic pain has resulted in increased opioid analgesic prescribing. The correlation between these two phenomena has led policymakers to posit that they are causally linked, and to implement policy changes supporting safe opioid prescribing. Purpose: To evaluate the impact of its Opioid Analgesic Risk Evaluation and Mitigation Strategy (REMS) program, the US Food and Drug Administration (FDA) requested the opioid manufacturers responsible for implementing that program provide information regarding opioid policy changes from 2016 to 2018. FDA also requested a survey of state requirements for pain and opioid prescribing continuing education (CE), the number of prescribers affected by those requirements, the extent to which a REMS-compliant CE program would meet each state's requirements, and the number of relevant CE programs available. Results: Results indicate that 527 federal and state opioid-related policies (statutes, rules/ regulations, and guidelines) were approved during the 2016-2018 study period. While the largest number of these policies focused on prescription drug monitoring programs, 170 specifically imposed limits on opioid prescribing and an additional 35 specifically referred to, or incorporated, the Centers for Disease Control and Prevention opioid prescribing guideline. We also found that 46 states and the District of Columbia mandated some amount of pain or opioid prescribing CE for prescribers renewing their licenses. These mandates potentially affected as many as 1.7 million prescribers. In 69% of cases, a REMS-compliant CE program would fully meet the state mandates for various types of prescribers. Conclusion: The severity and complexity of the problems of pain management and opioid overdose have led to large-scale intervention by policymakers. Assessing the impact of these changes is difficult, at best, but will be necessary if interventions are to be refined to increase their effectiveness.

Pain and Management of Pain: A Clinical Review for Craniofacial Surgeons

“…31 Many state medical licensure boards now require specific continuing education devoted specifically to improve the safety and effectiveness in the use of this class of therapeutics. 32,33 To understand how opioids alter perception of pain, we must explore the very essence of human desire and drive, a fascinating subject in and of itself. Advances in event-based functional magnetic resonance imaging (fMRI), molecular neurobiology, and endogenous opioid receptors have made such understanding possible.…”

Benzodiazepines: Thinking outside the black box

“…There have been benefits for REMS opioid programs: 46 states in the United States plus the District of Columbia now mandate some form of continuing education for opioid prescribing. 22 Some REMS programs for opioids appear to have decreased intentional misuse of the drugs and raised awareness and appreciation of their risks. 23,24 Of course, it is not always possible to determine whether changes to prescribing or consumption patterns are based on REMS, other factors, 24 or a combination.…”

“…BZDs are largely generic rather than branded products, and generic manufacturers may balk if BZD REMS requirements are imposed. There have been benefits for REMS opioid programs: 46 states in the United States plus the District of Columbia now mandate some form of continuing education for opioid prescribing 22 . Some REMS programs for opioids appear to have decreased intentional misuse of the drugs and raised awareness and appreciation of their risks 23,24 .…”

Misinterpretation of the “Overdose Crisis” Continues to Fuel Misunderstanding of the Role of Prescription Opioids

“…A study published by Duensing et al assessed such policies from 2016–2018, finding that 527 opioid related policies were approved during this time with 170 specifically imposing limits on opioid prescribing. 37 Additionally, 35 of these policies specifically mentioned or integrated the CDC Opioid Prescribing Guideline to support their narratives. 35 This is concerning due to the inherent problems associated with the use of “MEDD”, as there are significant gaps in absolute dose equivalents, variability between different calculators themselves, and unknowns in terms of equivalence from an adverse effect perspective.…”