Misuse of Narcotics May Call for Additional Doctor Training

Rockville, MD (Aug. 21)-The US Food and Drug Administration may soon ask doctors to undergo special training to be able to prescribe powerful narcotics, Dr. Bob Rappaport told The New York Times last week. Rappaport, director of FDA’s Anesthesia, Analgesia and Rheumatology Products division, said the agency is considering recommending additional education for doctors in early 2009, as FDA doesn’t have the authority to require such training-that authority rests in the hands of state medical boards.

More attention is being paid to this controversial issue as reports of improper use of painkillers have increased in recent months, despite FDA alerts. The drugs under concern include methadone, fentanyl, and some forms of oxycodone.

FDA issued a second safety warning on the Fentanyl skin patch, which contains opioid fentanyl, in December 2007 after continuing to receive reports of deaths and life-threatening side effects. Doctors have inappropriately prescribed the patch, whose directions need to be followed exactly to avoid overdose, and patents have incorrectly used it, according a Dec. 21 FDA release.

Methadone, another opium-based drug, has been implicated in more than twice as many deaths as heroin and is close to overreaching deaths related to OxyContin and Vicodin, reports TheNew York Times. This drug, in particular, has been associated with drug abusers. The number of methadone prescriptions went up 700% between 1998 and 2006, and yet, reports the Times, too few doctors understand how patients differ in their responses to the drug.

Currently, doctors only need to be licensed and registered with the Drug Enforcement Administration to be able to prescribe narcotic drugs, but pain experts are calling for increased education even though it may limit the number of doctors prescribing such medications, according to TheNew York Times. Rappaport told the Times that FDA may also ask drugmakers to develop programs to monitor how narcotics are prescribed.

Read the transcript of the May 2008 Joint Meeting of FDA’s Anesthetic and Life Support Drugs Advisory Committee, and the Drug Safety & Risk Management Advisory Committee, addressing fentanyl.

For more on this topic, see "Doctors and Narcotics–More Training, Please" on PharmTech Talk.