Online Training Tools Aim to Curb Prescription Drug Epidemic

Megan Brooks

October 03, 2012

October 3, 2012 — The Office of National Drug Control Policy (ONDCP) and the National Institute on Drug Abuse (NIDA) have announced the launch of online learning tools on proper prescribing and patient management practices for patients with chronic pain taking opioid analgesics.

NIDA director Nora Volkow, MD, joined White House drug policy director Gil Kerlikowske in making the announcement during a media briefing held October 1 in Washington, DC.

Using a "test-and-teach" approach, the online modules include several video vignettes that model doctor-patient conversations on the safe and effective use of opioid pain medications.

One module is called "Safe Prescribing for Pain," and the other is called "Managing Pain Patients Who Abuse Prescription Drugs."

Dr. Volkow reported that roughly 5000 physicians have taken the courses so far, which is "quite impressive."

"Science-Driven"

Physicians can access the training modules for CME credit during the first year — and possibly beyond the first year pending recertification — on the Medscape Web site. Each module is worth 1.25 continuing medical education (CME) credits.

Carol Krause, MA, chief, Public Information and Liaison Branch, Office of Science Policy and Communications at NIDA, told Medscape Medical News that NIDA will have the courses on its own Web site beginning in about 2 weeks, and they will remain on the site as long as the material is up to date.

"So anyone will be able to view and take the course, but not for CME credit since we are not an accrediting agency," she noted. The courses can be adapted for use in academic medical schools.

"ONDCP funded the project, basically giving NIDA the money to develop and produce the content," Krause said. "Much of the funding went from us to Medscape, whose experts pulled a lot of the content from our existing materials and made suggestions on how to proceed, given their expertise on CME development. Obviously, resources were also needed for formative research with clinicians, to shoot and edit the videos, format and design the Web pages, etc."

"ONDCP experts sat on the review panel as we proceeded, and were constant contributors to the overall project. However, it was important to ONDCP that the project was science-driven, and we appreciated their trust," she added.

"Prescription drug abuse in the United States is an epidemic," Kerlikowske said during the briefing. "In 2009, over 20,000 people died from prescription drug overdoses and opioid analgesics where involved in other 15,000 of those deaths. That's nearly 4 times the number of people who died from opioid analgesics a decade earlier. Overdose deaths involving these drugs now outnumber deaths from heroin and cocaine combined."

"It's clear to this administration that this public health emergency takes too many lives, tears apart too many families, and places too many economic burdens on communities across the nation," he added.

A NIDA survey released last week provides some encouraging news, Kerlikowske noted, showing a 12% drop in the number of Americans abusing prescription drugs between 2010 and 2011. The decline has been driven by a 14% drop in the number of young adults aged 18 to 25 abusing those drugs. "We are starting to bend the curve on the issue but the truth is we can't take our eye off the ball," Kerlikowske said.

Lack of Training

"At the end of the day," he said, "it's the physicians who prescribe these powerful drugs who have an important role to play by ensuring that painkillers are prescribed safely and effectively. Healthcare providers are an important line of defense against prescription drug abuse, (yet) very few hours are devoted in medical school to safe and effective pain management."

"Unfortunately, this lack of training can lead to improper prescribing of powerful painkillers. Training in proper opioid prescribing should be a prerequisite to anyone who prescribes (these) types of drugs," Kerlikowske said.

Reached for comment, Mark Sullivan, MD, PhD, professor of psychiatry and behavioral sciences at University of Washington, Seattle pointed out that opioid prescribing is complex.

"It's not just knowing pharmacokinetics, or dose equivalents, or drug interactions," Dr. Sullivan said. "It's understanding what are the proper goals for pain care, what can and can't be accomplished with opioid therapy, and what to expect from which patients. Screening patients is part of the latter task, but it is not a simple yes/no decision."

Dr. Volkow said, "We are very aware that part of the task of physicians is not only how to prescribe these medications but also how to educate their patients on the risk associated with improper use of the medication, which may include using more than prescribed or lending them to friends for purposes that are not correct."

The online training tools include videos of patients seeking help for their chronic pain and how physicians interact with these patients. The videos show physicians "asking the patient questions that are sensitive and that many physicians may feel uncomfortable asking. The idea is that seeing the videos may help physicians feel more comfortable when faced with similar situations," Dr. Volkow explained.

The NIDA says the e-learning tools build on a series of efforts previously announced by the Obama Administration designed to address the nation's prescription drug abuse epidemic through a balanced public health and safety approach and support the Administration’s goal of reducing the misuse of prescription drug abuse by 15% by 2015.

A copy of the Administration's report, "Epidemic: Responding to America's Prescription Drug Abuse Crisis," is available here.

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