Dr. Asif Ilyas: Opioid settlements, prosecutions are heartening, but education still necessary

A $26 billion settlement with opioid manufacturers in March. A $13.8 billion settlement with pharmacies in November. And jail time for prescribers across Pennsylvania and the nation over the past few years. These settlements with the manufacturers and purveyors of narcotics and the prosecution of “pill mill” doctors are heartening. But more needs to be done, and education remains a key element in combating the opioid addiction crisis.

The good news is that the Pennsylvania Department of Health’s Prescription Drug Monitoring Program (PDMP) is working. According to the Rothman Opioid Foundation’s study of data supplied by the department, Pennsylvania experienced a 33% decrease in the overall quantity of opioid pills prescribed three years after PDMP implementation. The largest decrease in prescribing habits occurred in the first two years. The rate slowed in the third year but still registered a decline.

This analysis demonstrates that the physician community not only understands the opioid addiction crisis’ nature but is positively acting to curb opioid prescribing. The study further documents a decline in physician opioid prescribing habits, such as fewer opioids prescribed, shorter prescription lengths and limited refill authorizations. Physicians, particularly surgical specialists, have been on the front line of the opioid addiction crisis for many years, and not always in a good way. We are now effectively using updated opioid scientific information to keep patients safe and avoid prescription opioid abuse.

Data demonstrates that opioid education needs to progress beyond the physician community. Allied professionals, known as “physician extenders,” also need high quality and accurate information regarding opioid use and abuse.

Pennsylvania’s physician assistants (PAs) and nurse practitioners (NPs) have prescriptive rights, but their training is not like osteopathic or allopathic doctors. These allied health professionals are vital members of patients’ continuum of care and practice under physicians’ supervision. And like doctors, they should receive more targeted opioid and pain management education before they begin to treat patients. This training is important to all physician extenders and is vital for PAs and NPs who practice in medically underserved regions such as Appalachia and Southwestern Pennsylvania, areas in which the opioid addiction crisis has been particularly brutal.

The Appalachian Regional Commission (ARC) and the Pennsylvania General Assembly recognized this need in PA and NP opioid prescribing education and training. They authorized the Rothman Opioid Foundation to create and distribute an opioid and pain management curriculum, especially for these important allied providers. The certificate training program is free, online and self-paced. More than 75 PA and NP training programs across the commonwealth have been given no-cost access to the curriculum. We are working to integrate the program into the clinical phases of PA and NP training this academic year. Further, we intend to distribute the curriculum throughout the Appalachian region in 2023.

Soon, patients can have confidence that if their PA or NP considers prescribing opioids, their providers have been fully trained on opioid prescribing best practices and, more importantly, alternative pain management modalities. That is the shared goal of the ARC, the General Assembly and the foundation. We encourage all PA and NP training programs to adopt this invaluable free resource.

Asif Ilyas, M.D., is president of the Rothman Orthopaedic Institute Foundation for Opioid Research and Education in Philadelphia, associate dean of clinical research at Drexel University College of Medicine and a professor at Jefferson Medical College.