Hearing Reveals Lawmakers’ Views on Providers’ Roles in Opioid Crisis

In reviewing several legislative proposals to combat the nation’s opioid crisis, members of a House of Representatives subcommittee on February 28 opined on the need for healthcare providers to receive special training on prescribing and dispensing opioid-containing products.

“As we consider solutions critical to blunting this crisis, we must strike a careful balance prior to casting blame,” advised Michael C. Burgess (R-TX), who chairs the House Energy and Commerce Committee’s subcommittee on health and ran the hearing.

Burgess, a physician, made the comment after briefly describing the last of 8 House bills concerning opioids and the Controlled Substances Act.

Under the Opioid Preventing Abuse through Continuing Education Act of 2017 (H.R. 2063), physicians and midlevel practitioners would need to complete at least 12 hours of special training during each 3-year registration with the Drug Enforcement Administration. This training would cover treatment guidelines and best practices for pain management, early detection of opioid addiction, and the treatment and management of opioid-dependent patients.

The bill was introduced in April 2017 by Representative Brad Schneider (D-IL) and has 12 cosponsors, none of them physicians.

Burgess, who describes himself as the chamber’s “most senior medical doctor,” said he rarely wrote a prescription for more than 12 doses of a controlled substance while in surgical practice in the 1980s and 1990s.

“It just seems like the world changed somewhere between the late 1990s and the end of the first decade of the 21st century,” he said.

Committee Ranking Member Frank Pallone Jr. (D-NJ) earlier in the hearing asserted that many of the “older doctors” may not be aware that overprescribing opioids is dangerous.

“I think doctors are part of the problem,” Pallone said, quickly clarifying that physicians, in his opinion, oftentimes believe they must prescribe drugs, such as opioids, to address patients’ pain.

And physicians develop that belief from their education, he said.

Representative Larry Bucshon (R-IN), a cardiothoracic surgeon for 15 years before serving in Congress, faulted hospital-accrediting organizations, patient advocacy groups, nursing groups, and physician groups for a “big push” in the 1990s to control pain.

Bucshon said he has talked with the Association of American Medical Colleges about the group’s members adding to their curricula or residency programs training in the assessment and proper treatment of pain.

Congress’s only pharmacist, Representative Buddy Carter (R-GA), used the time allotted to him to talk about 2 opioid-related bills that he cosponsors, 1 of which is the Empowering Pharmacists in the Fight Against Opioid Abuse Act (H.R. 4275), which would direct the federal government to provide programs and materials to train pharmacists how to decline to fill controlled-substance prescriptions suspected of being “fraudulent, forged, or otherwise indicative of abuse or diversion.”

Carter said pharmacists want to be able to identify fraudulent prescriptions.

But worse than unintentionally dispensing opioids for abuse or diversion, the former hospice consultant pharmacist said, would be declining to fill a prescription that is truly needed.

“I don’t want to have to profile,” Carter said while questioning Susan A. Gibson of the Drug Enforcement Administration during the hearing. “It’s unfair for you to expect me to have a patient come in and for me to make a decision by looking at that patient and saying that . . . they don’t look like they need this, and I’m supposed to keep them from having it. That’s simply not right and something that I am not trained in.”

In addition to providing that training, the federal government would be required by the bill to provide pharmacists with information on actions to take after declining to fill a prescription and to provide other healthcare practitioners and the public with information on the “pharmacist’s responsibility to decline to fill prescriptions in certain circumstances.”

ASHP Chief Operating Officer and Senior Vice President Kasey K. Thompson said after the hearing that addressing the opioid crisis in an interprofessional fashion and with a systems-based approach is a top priority for the organization.

“Pharmacists play a key role as the medication therapy experts on the interprofessional team to help ensure that the appropriate pain management therapy is selected at the point of prescribing, including the use of nonopioid therapy when possible,” Thompson stated.

ASHP recently convened an interprofessional commission of physicians, nurses, pharmacists, government officials, and various other stakeholders to develop actionable solutions to address the opioid crisis. Proceedings of the commission’s meeting will be published in a forthcoming issue of AJHP.

Committee Chairman Greg Walden (R-OR), without commenting specifically about any of the bills, during the hearing expressed his desire to get the full House of Representatives to vote on opioid-related legislation by Memorial Day.

[This news story appears in the May 1, 2018, issue of AJHP.]