Opioid Epidemic

Arizona governor pushes for opioid-related CME

Two osteopathic addiction specialists explain how primary care physicians can help combat the opioid epidemic.


In a letter to the Arizona Board of Osteopathic Examiners, Gov. Doug Ducey is calling for all Arizona physicians to take at least one hour of Continuing Medical Education (CME) related to addiction or opioid prescribing.

Citing a national survey, Gov. Ducey noted that while over 80 percent of primary care doctors feel comfortable diagnosing hypertension and diabetes, under 20 percent of primary care physicians are prepared to identify alcohol or drug dependence.

The survey also found that “more than 40 percent of patients stated that their physician missed the diagnosis of a substance use disorder.”

Michael Dekker, DO, an addiction psychiatrist in Phoenix, stands behind Gov. Ducey’s call to improve treatment by increasing CME requirements.

“Physicians who don’t have up-to-date training on pain medication and addiction don’t understand how much they can reduce the risk of patients with addiction using opioid medications,” says Dr. Dekker.

Addiction specialists say colleagues in primary care receive little education to prepare them to care for patients with substance use disorders, which are life-long health conditions.

Michael Levy, DO, DFASAM, medical director of the Center for Addiction Medicine in Las Vegas, believes CME on pain management will help PCPs:

  • Increase knowledge on safe, effective prescribing
  • Appropriately use and implement state prescription monitoring programs
  • Be aware of clinical presentations of patients who misuse opioids
  • Develop effective treatment strategies for dealing with addiction disorders, including when to refer to addiction specialists

Dr. Levy says many physicians have misconceptions about addiction based on a lack of understanding of the disease process.

“People do not choose to become drug-addicted,” he says. “If you were to look at it from a physical medical perspective, substance abuse disorders would be defined as chronic progressive relapsing diseases of the brain that may be fatal.”

Dr. Dekker also classifies addiction as a brain disorder, characterizing it as “a derangement of the reward process.” He says it’s rare to find physicians in Phoenix who are trained in addiction management, which means primary care doctors are in a unique position to help patients.

“No matter what your specialty, you’re going to see [substance use] disorder,” says Dr. Levy. “Any physician might have the opportunity to intervene and help individuals make decisions about whether he or she should go into treatment. In order for that to happen, physicians must have some knowledge of it.”

The death rate from opioids in Arizona is higher than any previous year and nationally 91 Americans per day lose their lives to opioid overdose. Boosting CME credits related to addiction medicine and opioid prescribing is advisable no matter what the state requirement.

Dr. Dekker encourages physicians to connect with the American Osteopathic Academy of Addiction Medicine, which will offer seminars at OMED 2017. CME is also available through the American Society of Addiction Medicine and the American Academy of Addiction Psychiatry.


  1. Bill Carnett

    …cynical yes, but true:

    in 2000 states began requiring “pain” cme to make sure physicians recognize the severity and impact of pain….so bingo, everybody (many who didn’t need) is on opiates. Now we will reqire a 1 hour course to, again, “educate” these uneducated physicians and that will solve the program. Unlikely. It will create another opportunity for more bureaucracy and not address the problem. If you (Arizona, et al) must make one more “rule,” how about “prohibiting” the use of pain as the 5th vital sign. How about encouraging physicians…young and old, to treat patients appropriately without adding burdens from regulatory or perceived regulatory burdens. Stick up for the poor doc who tells the fibromyalgia patient that they will not benefit from opiates…when that same patient goes running to the medical board with a complaint.

    No, I’m not an anarchist, but government does not make medicine (and nearly every other area) better through rules and intervention.

    How about eliminating direct to consumer drug ads? Help the patients and the docs.


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