Three years ago, because of increasing misuse and abuse of opioid medications––particularly extended-release (ER) and long-acting (LA) opioids like OxyContin––the FDA began working on the development of what they call a risk evaluation and mitigation strategy (REMS). Earlier this week, the FDA announced that they had approved a REMS that applies to ER and LA opioids.
According to the FDA, “The REMS is part of a federal initiative to address the prescription drug abuse, misuse, and overdose epidemic. The REMS introduces new safety measures designed to reduce risks and improve the safe use of ER/LA opioids, while ensuring access to needed medications for patients in pain.”
“Misprescribing, misuse, and abuse of extended-release and long-acting opioids are a critical and growing public health challenge,” said FDA Commissioner Margaret A. Hamburg, M.D. “The FDA’s goal with this REMS approval is to ensure that health care professionals are educated on how to safely prescribe opioids and that patients know how to safely use these drugs.”
Key components of the ER/LA opioid analgesics REMS include:
Training for prescribers. Based on an FDA Blueprint, developed with input from stakeholders, educational programs for prescribers of ER/LA opioids will include information on weighing the risks and benefits of opioid therapy, choosing patients appropriately, managing and monitoring patients, and counseling patients on the safe use of these drugs. In addition, the education will include information on how to recognize evidence of, and the potential for, opioid misuse, abuse, and addiction, and general and specific drug information for ER/LA opioid analgesics.
Updated Medication Guide and patient counseling document. These materials contain consumer-friendly information on the safe use, storage and disposal of ER/ LA opioid analgesics. Included are instructions to consult one’s physician or other prescribing health care professional before changing doses; signs of potential overdose and emergency contact instructions; and specific advice on safe storage to prevent accidental exposure to family members and household visitors.
Assessment/auditing. Companies will be expected to achieve certain FDA-established goals for the percentage of prescribers of ER/ LA opioids who complete the training, as well as assess prescribers’ understanding of important risk information over time. The assessments also cover whether the REMS is adversely affecting patient access to necessary pain medications, which manufacturers must report to FDA as part of periodic required assessments.
It is expected that the first continuing education activities under the REMS will be offered to prescribers by March 1, 2013. There is no mandatory requirement that prescribers take the training and no precondition to prescribing ER/LA opioids to patients. However, the Obama Administration is pursuing legislation that would require physicians to take the training before they could register with the DEA in order to prescribe opioid medications.
I certainly have no objection to better educating both medical professionals and patients on the appropriate and safe use of opioid pain medications. My only concern about the REMS all along has been whether or not they would discourage some doctors from prescribing opioids for chronic pain patients who need them. As they currently stand, I don't see anything in the new REMS that should have a negative impact on chronic pain patients. As for the possibility of legislation that would further restrict opioid prescribing, I'll have to wait and see exactly what is included in the bill before I can comment.
Published On: July 12, 2012