Erin Sherer, Ed.D, PA-C, RD
AASPA President Elect
Article originally printed in Sutureline: May/Jun 2017 p. 8
A critical problem facing the health profession is the epidemic involving prescription drug abuse and overdose. According to the National Vital Statistics produced by the Center for Disease (CDC), opioid overdose death rates in the United States (US) have quadrupled since 1999, and more people died from drug overdoses in 2014 than any year on record. This is a key topic for clinicians, health educators, and public health experts because it will be especially important to promote appropriate and safe use of prescription medications to curtail this epidemic.
Many physician assistants have their own Drug Enforcement Administration (DEA) number and, depending on their clinical setting, may prescribe opioids regularly. Some states (but not all) require providers with a DEA number to participate in opioid training programs every 1-3 years. These programs encourage providers to stay up-to-date with the current recommendations on prescribing these medications. Typical courses cover: pain management (acute and chronic), appropriate prescribing of medications, addiction warning signs, addiction prevention, addiction screening, caring for those with addictions, and managing pain at the end of life.
In 2015, Johns Hopkins Bloomberg School of Public Health published a guide, titled the “The Prescription Opioid Epidemic: An Evidence Based Approach.” In this guide, they reviewed what was currently known about prescription drug misuse, abuse and overdose and aimed to identify methods to prevent future injury from these medications. They developed recommendations for action that included: prescribing guidelines, prescription drug monitoring systems, improved pharmacy awareness, engineering strategies, overdose education, addiction treatment, and community-based treatment strategies. This is also top priority for the U.S. Department of Health and Human Services (HHS) which created an initiative targeting three priority areas including: improving prescribing practices, expanding access to and the use of medication-assisted treatment, and expanding the use of naloxone (the drug used to reverse overdoses). Additionally, the CDC has created guidelines for clinicians who are prescribing opioids for chronic pain.
Public health efforts to address this issue are moving in the right direction. Evidence-based interventions exist and are being implemented across the country. I suspect (and hope) that the following will happen: more restrictions on prescribing medications of abuse, increased training for clinicians on how to safely prescribe controlled substances, increased medication-assisted treatment programs for individuals seeking treatment from opioid abuse, improved recognition of cases of controlled-substance abuse to help bring in law enforcement and public health experts into areas before epidemics occur, and policies encouraging safe strategies to treat overdoses. I think that providing education to everyone in the health field (all providers, pharmacists, nurses, health educators and policy experts) and creating synergistic relationships among these individuals will help disseminate information to the public.
One potential roadblock for moving forward is, of course, a lack of funding to support some of these ideas. Unfortunately, limited funding may prohibit education efforts, access to law enforcement assistance, new technologies to monitor controlled substance use, and access to addiction treatment centers for those who seek it. Another potential hindrance is that if the Affordable Care Act is repealed (or modified), this could worsen the opioid epidemic as millions of Americans would lose access to medical care to treat substance use disorders.
The key point of this article is to reiterate that physician assistants should be aware of the potential risks associated with prescribing pain medications to patients. We should do our best to help prevent abuse of these medications by staying current with national (and state) guidelines regarding their use. Many organizations have created tools for prescribers to utilize to help recognize patients who may be at risk of (or have a history of) misusing opioid medications. As physician assistants, we have a responsibility to our patients and our profession to think carefully each and every time we prescribe a medication that could cause potential harm. I have modified my own prescribing patterns, and I encourage you to take advantage of the resources available to you to do the same. As prescribers, we have an important role in the opioid epidemic and we should do our best to combat it.