To:Governor John Bel Edwards

Louisiana Opioid Commission

From: Issue #6 Workgroup

SreyRamKuy,MD, Team Lead

LouisianaCommission on Preventing Opioid Abuse

Topic #6:

Evaluate medical professional training needs and the efficacy of educational materials and public education as an outreach strategy to raise public awareness about the dangers of misuse and abuse of opioid drugs.

Team Members

Designee / Representing:
SreyRam Kuy, MD, Team Lead / Louisiana Department of Health (LDH), Medicaid
Leslie Brougham Freeman / LDH, Office of Behavioral Health
Jennifer Marusak / Louisiana State Medical Society
Eric Torres / Louisiana State Board of Medical Examiners
Malcolm Broussard / Louisiana Board of Pharmacy
James Taylor, Jr. / Louisiana Academy of Family Physicians
Ragan LeBlanc / Louisiana Academy of Family Physicians
Deborah L. Thomas / Louisiana Addictive Disorders Regulatory Authority
Thad Toups / Louisiana Association of Drug Court Professionals
Lisa Bayhi / Louisiana Association of Nurse Practitioners
Adrianne Trogden / Louisiana Association of Substance Abuse Counselors & Trainers
Benjamin Record / Louisiana Dental Association
Ken Roy, III / Louisiana Psychiatric Medical Association
Cynthia York / Louisiana State Board of Nursing
M. Lynn Ansardi / LouisianaState Board of Practical Nurse Examiners
Rita Finn / Louisiana State Nurses Association
Jamie Bolden / LSU Health Sciences Center at New Orleans
G.E. Ghali / LSU Health Sciences Center at Shreveport
Chuck Cox / LSU Health Sciences Center at Shreveport
Monica Morgan / Louisiana Society of Health System Pharmacists
Mitch Bratton / Louisiana Association of Chiefs of Police
John DeRosier / Louisiana District Attorneys Association
Michael Ranatza / Louisiana Sheriffs' Association
Paul Hubbell / Society of Interventional Pain Physicians of Louisiana
Ginny Hammett Martinez / Pharmaceutical Research & Manufacturers of America
Russell Caffery / Louisiana Independent Pharmacies Association
Beau Clark / Louisiana State Coroner's Association
Keetsie Gunnels / Louisiana Departmentof Justice
Rochelle Head-Dunham / Metropolitan Human Services District
Joseph Kanter / New Orleans Department of Health
William Kirchain / Louisiana Pharmacists Association
Monica Morgan / Ochsner Medical Center – Baton Rouge
Marianna Maumus / Ochsner Medical Center – Baton Rouge

Background, Current Policies, Statutes, Regulations:

  • Drug Enforcement Agency (DEA) creates the rules for controlled substances (21 CFR 1300 to end). Govern manufacture, distribution, prescribing, to dispensing of controlled substances, but nothing relative to education of practitioners.
  • State authority varies from state to state. In Louisiana, the Board of Pharmacy issues all Controlled Dangerous Substance (CDS) licenses. Louisiana CDS licenses require evidence of the primary professional license that is active and unrestricted. The CDS license is then used to apply for DEA registration.
  • Example of one strategy: Tulane Medical School
  • Two hours on opioids for second year students
  • Two days on opioids for medical students enrolled in psychiatry in their third year
  • No formal training in addictions in any residency program except psychiatry

Best Practices/Guidelines:

  • American Society of Addiction Medicine (ASAM)
  • National Practice Guideline For the Use of Medications in the Treatment of Addiction Involving Opioid Use
  • ASAM Criteria, comprehensive set of guidelines for placement continued stay and transfer/discharge of patients with addiction and co-occurring conditions.
  • Washington State
  • State’s Agency Medical Director’s Group (AMDG) provides three different free CME activities, online for providers for a maximum of 4, 3 and 1 AMA PRA credits separately. Satisfies re-licensure requirements of the Washington State Medical Quality Assurance Commission.
  • Also provides 0.3 CEU credits for pharmacists.
  • CME educates on best practices in prescribing opioids for chronic non-cancer pain, the use of opioids after acute injury or surgery, and in special populations (pregnant women, pediatrics, elderly, and cancer survivors), alternatives to opioids, and when to initiate treatment for addiction. The material incorporates video, written and test questions.
  • Free and easily-accessed CME helps ease the burden on providers, facilitates completion at providers’ convenience, and provides a venue for meeting licensure requirements.
  • American Medical Association (AMA)/American Academy of Addiction Psychiatry
  • Enhance physicians' education on effective, evidence-based prescribing
  • Reduce the stigma of chronic pain and promote comprehensive assessment and treatment
  • Reduce the stigma of substance use disorder and enhance access to treatment
  • Expand access to naloxone in the community and through co-prescribing
  • Enhance physicians’ education on effective, evidence based prescribing
  • AMA Task Force to Reduce Opioid Abuse
  • The AMA and members of the Task Force to Reduce Opioid Abuse are collaborating on the Providers' Clinical Support System (PCSS-O) initiative, funded by the Substance Abuse and Mental Health Services Administration and administered by the American Academy of Addiction Psychiatry. The PCSS-O project maintains an inventory of more than 100 online modules and webinars on topics at the intersection of pain, opioids and addiction, as well as a support network.
  • Maryland requires 1 hour of safe opioid prescribing in its 50 hours every two years;
  • Massachusetts requires 3 credits of opioid education and pain management training as a condition for license renewal;
  • New Mexico requires every licensee who holds a DEA registration and license to prescribe opioids to complete 5 CME hours.

Findings and Recommendations:

CME programs on:

  • best practices in prescribing opioids for chronic non-cancer pain
  • the use of opioids after acute injury or surgery
  • the use of opioids in special populations (pregnant women, pediatrics, elderly, and cancer survivors), alternatives to opioids
  • when to initiate treatment for addiction
  • the proper prescribing of buprenorphine available throughout the state.

Evidence based treatment requirements for residential treatment programs (would only require an order of the Secretary) to embrace the use of maintenance medications in residential treatment programs.

Public education on the availability of Narcan® Nasal Spray.

OTC status for Narcan® Nasal Spray

Commitment to prevention and treatment.