Dr. Scott Gottlieb Says Opioid Crisis Too Big for Any One Entity to Significantly Impact It

Dr. Scott Gottlieb Says Opioid Crisis Too Big for Any One Entity to Significantly Impact It

In a far-ranging interview for CNN by Dr. Sanjay Gupta, FDA chief Dr. Scott Gottlieb reaffirmed earlier statements that the opioid crisis is the biggest challenge facing his agency today.

"This is the biggest crisis facing the FDA," Gottlieb said. "But this crisis has gotten so big that it's beyond the purview of any one entity to really impact it in a very meaningful way. I think the way we're going to do so is by working together, not just at a federal level but also at a state and local level."

The main role of the FDA will be to address overprescribing of opioids, Gottlieb said. Overprescribing is one of the sources of the opioid problem, and has been since the 1990s when physicians were trained to aggressively treat pain as one of the "vital signs" of a patient's condition.

30 pills for a toothache?

As we reported last year, Gottlieb believes the key to reducing new addiction is to reduce exposure to opioids in the clinical setting.

Too many opioid pills are being prescribed for minor pain, and they don't all get used, he said. A recent FDA survey found that only one day of opioids is necessary to control pain for most outpatient procedures. Yet doctors continue to prescribe 30 days of opioids for something as simple as a tooth extraction.

"Those pills are going in the medicine cabinet, and they're becoming a river of drugs in our neighborhoods," Gottlieb said. "When you have tens of millions, even hundreds of millions of prescriptions being written, that's a lot of potential for abuse, so I think a key is to try to bring down overall exposure to these drugs."
"I think doctors from our generation were trained that pain was a vital sign and there was more liberal prescribing of these medications," he told Gupta. "We now recognize that wasn't appropriate. So I think there needs to be some effort to re-educate a generation of physicians. I think some form of mandatory education would make sense."

Training in addiction treatment

To be able to prescribe controlled substances, doctors must register with the DEA after med school, and again every three years. Gottlieb said that might be a good time for extra training about opioids and prescribing. The new training could also include how to treat addiction.

"So, at the very time you're educating them about the appropriate prescribing of opioids, you're also educating them about how to spot signs of abuse and treat it if they do have a patient who becomes addicted," Gottlieb said.

New labeling is being worked on that will include standards for specific conditions and procedures. Prescriptions will only be for the recommended number of pills instead of the usual and often unnecessary 30-day supply. These new standards would be enforced, he said.

The FDA chief added that there are classes of patients with chronic pain or undergoing major surgery that have needs that must also be met.

"We can't lose sight of people who have appropriate medical reasons to be using these drugs," he told Gupta. "And in some situations, opioids are the only thing that's going to work."

AMA offers some ideas

The American Medical Association (AMA) favors continuing physician education, but has gone on record as opposing federally mandated "one size fits all" training. It also has objections to modifying labels to reflect mandated prescribing guidelines, which it says should remain the purview of the prescribing physician.

In a letter to the FDA last December, the AMA said,

"The AMA strongly supports the FDA's efforts to help ensure the safe and appropriate prescribing of opioid analgesics as a critical component of reversing the nation's epidemic of opioid-related misuse, overdose, and death."

But the AMA goes on to say that,

"more than 118,000 physicians recently have taken educational courses related to opioid prescribing, pain management, substance use disorders, and related topics offered by national organizations, including specialty societies, and state medical societies. An AMA survey found that what physicians feel is lacking and what they need most is opioid related education that is tailored to their own specialty and patient population."

The AMA said it offers more than 300 state- and specialty-specific education resources at a new AMA website called end-opioid-epidemic.org.

"We instead encourage the FDA to work to increase information about, use of, and dissemination of all of the effective strategies for treating pain and reducing the risk of opioid use disorders."

The FDA should consider "the full array of potential treatment strategies for pain, including opioids and non-opioid analgesics as well as non-pharmacologic options, instead of viewing opioids in isolation."

At Novus we believe educating physicians on opiate prescribing is vital to stopping the epidemic and we are here to continue to help those who are most immediately affected by this opioid epidemic: the patients.

Related Posts:

Start Your New Path to Sobriety Today!

    • Please enter your name.
    • This isn't a valid phone number.
    • Please enter your email address.
      This isn't a valid email address.
    • Please make a selection.
    • Please enter a message.