AAFP Cautions Against Mandatory Opioid Prescriber Training

“The AAFP strongly supports prescriber education programs to address overprescribing concerns but urges the FDA not to implement a mandatory training requirement for prescribers,” said a Dec. 2 letter to Janet Woodcock, M.D., the agency’s acting commissioner.

Such a training requirement “would be burdensome to physicians, many of whom have already sought additional training on pain management practices,” the Academy wrote. “These added burdens, such as the mandatory education requirement for physicians to obtain the X-waiver to provide substance use disorder treatment, have been shown to worsen access to evidence-based, appropriate care.”

The Academy was responding to “Reconsidering Mandatory Opioid Prescriber Education Through a Risk Evaluation and Mitigation Strategy (REMS) in an Evolving Opioid Crisis,” published Sept. 9 in the Federal Register. The letter was signed by AAFP Board Chair Ada Stewart, M.D., of Columbia, S.C.

The Academy highlighted that existing nonmandatory training was already leading physicians to improve their prescribing standards. Citing an AAFP position paper on chronic pain management and opioid misuse, the letter also acknowledged the responsibility primary care practitioners play in addressing the opioid epidemic.

“As of 2018, the average family medicine residency devotes about 33 hours of education to pain management topics,” the Academy said. “This additional training in medical school, family medicine residencies and through continuing education opportunities facilitates appropriate prescribing of opioids without restricting access to chronic pain management.

“The AAFP is also an accredited continuing medical education provider and has offered several courses for family physicians on appropriate prescribing, REMS and pain management.”

The Academy reminded regulators that a majority of U.S. opioid-related deaths involve illicit substances such as heroin and suggested that resources for mandated training “could be better used for implementation and use of prescription drug monitoring programs or the implementation of payment that supports more time-intensive, whole-person care for pain management.”