Doctors react to Obama prescription drug initiative

WASHINGTON – The Obama administration unveiled a new initiative to combat prescription drug abuse Tuesday, but some pain specialists say the plan – like the drugs it targets – fails to address the real issue.

Also, physician participation in the training programs will be voluntary – for now.

A key element of Obama’s plan is urging Congress to mandate physician training be a precondition to registering with the Drug Enforcement Agency. This has the American Medical Association on edge.

While they support the plan’s intent, the possibility of mandating training for doctors who prescribe addictive pain killers like morphine and oxycodone is a concern, said AMA President Cecil B. Wilson.

The AMA would not comment further on its concerns until specific legislation was drafted.

“There is an over emphasis in the medical system on medication to deal with pain,” said Dr. Peter Abachi. “We’re missing meat of the problem if we don’t give people the other tools.”

Those tools include physical therapy, psychology and mind-body therapy.

When used together, they address both the mental and physical causes of pain more effectively than medication alone, said Abaci, a clinical instructor at the Stanford Pain Clinic and co-founder of the Bay Area Pain and Wellness Center in Los Gatos, Calif.

This is especially true when that medication is abused.

Accidental overdoses of prescription drugs killed more people that gun shots or heroin overdoses according to the most-recent data from the Center for Disease Control and Prevention.

Oxycodone, morphine, methadone and other drugs commonly prescribed to treat pain are the focus on President Barack Obama’s four-pronged plan to reduce abuse of the drugs by 15 percent in the next five years.

One of the major parts of the four-pronged plan announced by the White House Tuesday requires drug manufacturers to develop and implement a training program for health care providers, teaching them how to properly prescribe the medications.

While doctors definitely need more training on how to use pain drugs, they also need educated on more comprehensive treatment options, Abaci said.

“I see so many problems,” he said. “Patients come in now with a laundry list of [drugs] they’ve tried already and they’re looking at me to clean up the mess.”

Drug Enforcement Administrator Michele Leonhart was confident Congress
would back the administration’s effort.

“On prescription drugs they have been behind us all the way,” Leonhart said at a press conference Tuesday.

Legislation or not, patient education is mandatory and pharmacists will be responsible for distributing new medication guides developed by the pharmaceutical companies.

“As the medication experts, pharmacists stand ready to inform and educate the public about the medications they are taking,” said Michelle Fritts, a spokeswoman for the American Pharmacists Association.

Specific training plans and materials are not available yet.

Drug manufacturers making the targeted drugs were notified by the Food and Drug Administration of the agency’s intent to require a Risk Evaluation and Mitigation Strategy in February 2009, according to the agency’s website.

Pfizer spokesman Raul Damas said his company is working with other drug companies to determine how to train health care providers, and how to monitor their participation.

Drugs the FDA said would require the new educational guidelines include Johnson & Johnson’s Duragesic, Pfizer Inc unit King Pharma’s Avinza and Embeda, Actavis’ Kadian and Endo Pharmaceuticals’ Opana ER.

“We recognize our responsibility to physicians and patients and remain committed to being part of the solution to address this important public health and safety issue,” Damas said in an email.

Damas would not comment on the cost to implement the program, but said Pfizer actively participated in developing the recommendations.