Overprescribing is a key reason for the current opioid abuse epidemic, several speakers said here.

“While our office wants to ensure that those patients who need access to pain medication get it, we know all of the morbidity and mortality associated with this epidemic can be tracked to the vast overprescribing of prescription drugs in the United States,” Michael Botticelli, director of the White House Office on National Drug Control Policy and a recovering addict, said at a briefing here Wednesday sponsored by the Hazelden Betty Ford Institute for Recovery Advocacy and the National Council for Behavioral Health.

He noted that on average, medical students receive 11 hours worth of education on pain medication and virtually no education on substance use disorders. “That’s why our office … [plans] to call for mandatory education for every prescriber,” Botticelli said. “I don’t think that 10 years into this epidemic, it’s unreasonable to ask prescribers to have a minimal amount of continuing medical education to stem the tide of prescription drug abuse.”

Marv Seppala, MD, chief medical officer at the Hazelden Betty Ford Foundation, in Minneapolis, Minn., put it in harsher terms. “The Number One reason that this crisis exists is because of the prescribing of my profession,” he said. “We’re overprescribing opioids, and it’s the result of little training and too much reliance on bad information.”

Healthcare professional education is “completely lacking on addiction and limited in chronic pain,” he continued. “We get a great deal of information on [treating] acute pain, such as for a broken bone — and it is necessary to use opioids for moderate to severe pain. But for mild to moderate pain, we’ve lost our way and start to use these risky medications to treat … things like a sprained ankle.”

Seppala did add that there has “been recognition on the part of medicine to some degree and we are seeing waning of prescribing to some degree, but nonetheless it’s still way overdone.”

He was quick to say that physicians themselves aren’t to blame. “My fellow physicians really want to help people that are suffering … but most of them just don’t know how bad this is right now and the problems that they’ve been causing,” he said. “We need limitations on opioids and [we need] appropriate use of them.”

“One thing that has to be considered [during patient care] is a history of addiction and a family history of addiction,” he added. “That needs to be taken really seriously and screened for at every visit.”

Seppala suggested other possible solutions to the problem, including mandatory provider education, mandatory state prescription drug monitoring programs, and education of providers on nonmedical alternatives for pain treatment, as well as mandatory patient education.

Kentucky state representative John Tilley (D-8th District) criticized medical groups for speaking out against funding for a national prescription drug monitoring program. “It’s unfathomable to me that we wouldn’t fund something that just simply required doctors to say, ‘Let’s see what else this patient has been prescribed before I prescribe them these dangerous and highly addictive drugs,'” he said. “I want to take some doctors off the hook because some associations that scream loudest against that, I don’t think they’re speaking for doctors on the street.”

Tilley pointed out that veterinarians receive much more training in this area than physicians. “I think that’s a failure in the system; I don’t blame physicians for that.”

Jeannie Sperry, PhD, a clinical psychologist at the Mayo Clinic in Rochester, Minn. who specializes in chronic pain care, offered ideas for alternative types of strategies that physicians and patients could learn. “We need to teach [patients] mindfulness-based practices such as meditation, yoga, and tai chi. We need to teach them to gradually increase physical activity and cognitive techniques to self-manage their pain.”

Mehmet Oz, MD, a New York City cardiac surgeon and host of TV’s “Dr. Oz” show, also offered ideas, including encouraging families to have a discussion about this issue on Thanksgiving night. “We ought to do it Thanksgiving night, because what else brings up more mental health problems … than being with family for 4 days?” he said.

And, he added, “I think we need a new ‘fried egg’ commercial, a new way of talking about your brain on drugs. I don’t think we’re scared of heroin today the way I felt when I was a teenager … We need to tell that story in that way, loudly and clearly.”