Prescription for Change

US drug czar enlists DOs’ help curbing nation’s opioid epidemic

Michael Botticelli, who runs the Office of National Drug Control Policy, spoke with DOs at OMED about his office’s priorities.


Drug overdose deaths are now the nation’s leading cause of death from injury, according to the Centers for Disease Control and Prevention. In 2012, more than 22,000 people in the U.S. died by overdosing on pharmaceuticals. Since 1980, drug overdose deaths in the country have increased fivefold.

Hoping to educate physicians on the steps they can take to alleviate the problem, Michael Botticelli, acting director of the Office of National Drug Control Policy, shared some of his office’s main challenges, and its priorities involving physicians, Sunday during an OMED presentation.

In 2013, 6.5 million Americans reported using prescription drugs for nonmedical reasons, Botticelli said, and about 1 in 5 people using drugs for the first time often start with nonmedical use of a prescription drug.

“Many of you have seen the CDC study that came out just a few months ago that looked at the number of prescriptions for pain medications in the U.S.,” he said. “They estimated that we are now prescribing enough prescription pain medication to give every adult a bottle of pain medication.”

Botticelli urged physicians to obtain the necessary training to prescribe medications that can help patients overcome opioid addictions. Physicians need about eight hours of training to prescribe buprenorphine. Training typically covers details of the drug as well as the ways clinicians can combine the medication with behavioral therapy. Physicians can access training modules and also find mentors on prescribing opioids via the Providers’ Clinical Support System for Opioid Therapies.

Physicians who aren’t interested prescribing buprenorphine should at least know where to refer their patients, Botticelli said, and should get to know the community resources in their area and begin to establish referral relationships with area physicians who administer medication-assisted treatment.

Botticelli also stressed the importance of continuing medical education on prescribing opioids and opioid abuse. Physicians need to know not only how to prescribe opioids to patients who need them, but also how to assess whether a patient is at risk for addiction or becoming addicted to pain medication, he said.

Physicians can also use their state’s prescription drug monitoring database (PDMP). Most states now have one, and physicians can use them to check the up-to-date prescription patterns of their patients.

Botticelli’s office has been working on ways to make PDMPs easier for physicians to use, he said.

“All of you have busy practices,” he said. “We want to make sure that these are usable programs. We have been working with the Substance Abuse and Mental Health Services Administration [SAMSHA] and the Office of the National Coordinator, implementing pilot programs to look at how we might use technological patches to make sure that these programs are more usable. For instance, embedding the PDMP data within electronic health records is a really important opportunity to make sure that as you’re looking at your patients, you have good real-time data.”

Botticelli’s office has also heavily promoted the use of naloxone, the opioid overdose reversal drug, by the police and other first responders. When naloxone is more widely available to first responders, overdose deaths go down, Botticelli said. Physicians can also potentially reduce overdose deaths by co-prescribing naloxone with opioids, Botticelli said.

“We have a significant opportunity here to really make sure that we are not only expanding treatment, but also expanding opportunities to keep people alive so that we can get them into treatment,” Botticelli said.

Presentation attendee John Hart, DO, noted that statistics recently came out showing that more than half of prescriptions ordered by Oregon’s family physicians were for narcotics. He asked Botticelli what his office was planning to do to get physicians to change their prescribing behavior.

“Part of what we’ve been promoting is mandatory prescriber education, so that every physician, every prescriber has some level of education as it relates to safe and effective opioid prescribing,” Botticelli said in response. “We’ve been trying to accelerate that. We’re in partnership with the National Institute on Drug Abuse as well as SAMHSA to develop two online courses that prescribers can take … We also want to make sure physicians and prescribers are getting some level of education around addiction in general as part of their medical training.”

Presentation attendee Stephen A. Wyatt, DO, agreed that addiction education is necessary for medical students.

“My primary interest is to see that right from the beginning, medical students are trained to both identify and talk with and then treat people with substance use disorders,” said Dr. Wyatt, an addiction psychiatrist in Charlotte, N.C. “They need to understand from the very beginning that they are going to see patients with these problems in all areas of medicine.”

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