A recent AMA MorningRounds item reminded me of a new mandate by the Iowa Board of Medicine (IBM). The item is about a New York study which found “that in 2010 about 15 percent of physicians prescribing medications in the city were responsible for over 80 percent of prescriptions for opioid painkillers, while about 31 percent of such prescriptions were attributed to just one percent of the city’s physicians.”
That’s the typical few bad apples making it tough for the whole barrel. Nevertheless, the IBM has mandated that all primary care physicians and psychiatrists should undergo mandatory CME training in pain management, which is intended to address the overprescription of opioids which has led to the epidemic of deaths due to overuse of these analgesics.
I’m reposting my blog from February 18, 2012 on this issue:
“Remember that post on February 2, 2012, “Iowa Psychiatrists and Chronic Pain Mandate from the Iowa Board of Medicine”? And for further information, see my post from February 8, 2012, “Do State Prescription Monitoring Programs Influence the Therapeutic Alliance?”. Well, I just saw another news item that makes me wonder even more about these issues. American Medical News reports that these kinds of mandates are often reactions to popular press driven issues and one of them is the rising cost and death rate due to opioid overdoses. In fact, the American Medical Association is opposed to state-mandated continuing medical education (CME) content and advise local medical societies to urge that these rules be “rescinded or amended.”
In my February 8, 2012 post, I mentioned concerns about what a broad group of physicians the state Prescription Monitoring Programs were being applied to. An excerpt from that post follows:
One Massachusetts physician interviewed (also taken from the Boston Globe story) indicated a preference that the scope of the monitoring program, targeting physicians who specialize in treating pain.
By the same token, I wonder if the state-mandated CME programs, especially for opioid management of chronic pain, could target psychiatrists who are actually treating chronic pain with opioids. I think general psychiatrists and even Psychosomatic Medicine subspecialists who prescribe opioids are in a very small minority. I have never prescribed them. In my opinion, it is impractical and unnecessary to require all psychiatrists to participate in such programs. That doesn’t mean I think the problems they seek to address are unimportant. They are critically important issues for the health, well-being, and even survival of our patients. I just don’t believe it’s practical to make psychiatrists who never treat patients who have chronic pain and who never prescribe opioids sit through state-mandated opioid management CME programs.”
Also, see the related post, State Mandated Opioid Management CME Requirements for Psychiatrists « The Practical Psychosomaticist: James Amos, M.D.