Policy Options to Increase Physician Training Education in Proper Opioid Prescribing

Among the recommendations of the President's Commission on Combating Drug Addiction and the Opioid Crisis (President's Commission) is to mandate "medical education and prescriber education initiatives in proper opioid prescribing and risks of developing an SUD [Substance Use Disorder]."

This Insight focuses on physician efforts because physicians can prescribe in every state but not all states permit advanced practice nurses or physician assistants to prescribe opioids. Many of the policy options discussed in this Insight could also be applied to other provider types (e.g., nonphysicians) who have prescriptive authority.

Efforts to increase training on opioid prescribing for physicians could occur at three points during training:

  • 1. during medical school,
  • 2. during medical residency (i.e., as part of graduate medical education), and
  • 3. while in active practice (i.e., as part of the requirements to obtain or maintain a license).

Federal efforts to mandate such education may be limited at each of these levels. For example, the federal government does not have direct oversight over the content of medical school curricula, although it has some indirect influence because federal student loan funds are often available only to individuals who attend a school accredited by an approved body (the Liaison Committee on Medical Education or the Commission on Osteopathic College Accreditation). Attending an accredited medical school is also required to enter residency training. Medical schools determine their own curricula subject to standards set by the relevant accreditation body. Some medical schools have implemented opioid-prescribing curricula.

Prior to being licensed to practice independently, typically a physician must complete a residency. As with medical school curricula, the federal government does not have a direct role in setting the content of residency training, although it plays a large role in financing residency training.

Physician licensing occurs at the state level. As such, the federal government cannot mandate that certain training be required for state licensure or be required to maintain state licensure. State licensure, however, is required to enroll as a provider eligible for reimbursement from federal health programs (e.g., Medicare). States have made efforts to increase provider education about prescribing opioids, for example, by requiring continuing education courses in pain management for physicians licensed in that state.

The federal government does regulate the prescribing of controlled substances, including opioids, by requiring individuals who seek to prescribe controlled substances to register with the Drug Enforcement Administration (DEA). This registration generally requires the DEA to verify an individual's state license and does not require additional training.

What Levers Are Available to the Federal Government?

Although much of the authority to mandate prescriber education would occur through schools or through states, the federal government may have some leverage in encouraging or requiring this education. Examples of policy levers are discussed below. Specific examples are provided where options have been used.

These examples are some of the policy options that could be employed for training on safe opioid prescribing. These options could target physicians or a larger group of providers. While the options discussed in this Insight focus on opioid training, similar policy options could also be considered for other content areas, such as nutrition or end-of-life care.