MORE DETAILS about Prince's final days are emerging to the effect that the legendary pop star may have been addicted to prescription opioid painkillers at the time of his death in April. Officials have not yet confirmed that such medications caused Prince's death; the drugs may have had nothing to do with it. If, however, Prince was killed by an overdose, there would, sadly, be nothing unusual about it. Death from prescription opioids is an everyday occurrence in the United States; as a matter of fact, in 2014 it occurred about 52 times per day, according to the Centers for Disease Control and Prevention.
Belatedly, the federal government has bestirred itself against this epidemic, the origins of which lie in a movement toward more aggressive treatment of chronic pain beginning two decades ago — a movement blessed by various federal authorities, it must be said. Among those agencies was the Food and Drug Administration, which approved every single pill, from Percocet to OxyContin to Vicodin, that caused every single overdose. We hasten to emphasize the obvious: that the FDA approved these drugs for appropriate use, not abuse; and it did so with the best of intentions, to meet what was widely believed to be an unmet medical need. Pain management is a difficult and important medical task. Nevertheless, as evidence of rampant abuse and credible accusations of sloppy prescribing mounted, the FDA came under increasing criticism for its slowness in responding.
Cases in point: In 2012, an FDA advisory panel voted 11 to 2 against approving an opioid, Zohydro, citing addiction risks. The agency greenlighted it anyway. That same year, another advisory panel recommended that all doctors who prescribe powerful opioids should receive mandatory best-practices training. But the American Medical Association fought the rule as overregulation and the FDA opted to continue its voluntary approach — with the result that only about 40,000 doctors got the instruction, as opposed to the 80,000 the FDA anticipated.
Such concerns were behind Senate resistance to the new FDA commissioner, Dr. Robert M. Califf, who nevertheless won confirmation on Feb. 24 after reassuring lawmakers and the public that he would take criticisms of the FDA's past performance to heart. He pledged "a change in course" on opioids at the FDA, which, as he described it in a Feb. 5 blog post, would include "increas[ing] the number of prescribers who receive training on pain management."
Now he has an opportunity to make good on that pledge: A new FDA advisory panel voted Wednesday to make opioid-prescribing training mandatory for physicians. FDA officials have told reporters that Dr. Califf will, indeed, support the recommendation, thus undoing the agency's past error. There are still many difficult questions about how, specifically, to put such a requirement into practice. Doctors, though, need to take the opportunity to help craft a workable system rather than reassert their opposition. This would, in fact, be a very modest step toward combating a horrific public-health problem, part of a broader approach that won't work unless everyone involved, doctors very much included, gets with the program.
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