Therefore, we refer to national data from these four data sources as key  measures of prescription pain reliever abuse and misuse. The largest increases were in measures of adverse  health consequences, though increases were not consistent across all  measures. Federal officials suggested that increasing availability of  prescription pain relievers and increasing high-risk behaviors by those  who abuse or misuse the drugs, such as combining prescription pain  relievers with other drugs or alcohol, likely contributed to the rise in  adverse health consequences, though data about the reasons for the  increases are limited. Federal Agencies Are Using Various Strategies to Educate Prescribers about Issues Related to Prescription Pain Reliever Abuse and Misuse

FDA, NIH, and SAMHSA are using a variety of strategies to fill the gaps  federal agencies have identified in prescriber education related to treating  pain, prescribing opioids appropriately, and identifying substance abuse  in their patients, but officials told us that more education is needed. Strategies that these agencies pursued in fiscal year 2011 include  developing CME programs, requiring training and certification in order to  prescribe certain drugs, organizing physician mentoring networks, and  developing curriculum resources for future prescribers. Currently, in  order to register with DEA to prescribe a controlled substance,  prescribers must hold a valid state license.agencies we spoke with expressed support for mandatory prescriber  education, with some noting that this would ensure that all prescribers  were starting from the same baseline of knowledge. All Agencies Followed Almost All Key Practices; Efforts Varied in Size and Approach

All federal agencies used almost all of the key practices for developing  consumer education efforts when developing the efforts that we reviewed  to educate the general public about prescription pain reliever abuse and  misuse. Agencies varied in how they used the key practices for developing public  education efforts. All Agencies Followed the Key Practice of Establishing Process Metrics but Most Did Not Assess Program Outcomes

While all agencies established metrics to monitor the implementation and  functional elements of their educational initiatives, only two agencies have  established or planned to establish metrics to assess the impact of their  initiatives on audiences’ knowledge, attitudes, and behavior with regard to  prescription pain reliever abuse and misuse. Federal Agencies Have Begun Coordinating Similar Public and Prescriber Education Efforts, but Have Missed Opportunities to Share Resources

There are several similarities among agencies’ efforts, target audiences,  and mediums across the nine public education initiatives and nine  prescriber education programs we identified. Officials said that these  similarities in public education efforts are beneficial in addressing  prescription drug abuse and misuse because having multiple, reinforcing  messages about the same subject is valuable in public health  communications and because federal agencies provide slightly different  perspectives on the issues surrounding prescription drug abuse and  misuse. Likewise, the prescriber education programs we identified,  though similar, are different in content and focus. Although these similar  programs have the potential to be duplicative if not effectively  coordinated, federal agencies have recently begun to coordinate their  educational efforts. Develop and implement a plan to evaluate outcomes from the  proposed national education campaigns. Ensure that federal agencies undertaking similar educational efforts  leverage available resources and use coordination mechanisms to  share information on the development of their efforts. In written comments, reproduced  in appendix VI, ONDCP did not explicitly agree or disagree with our  recommendations, but noted that it will continue to work for improved  coordination of prescription drug abuse educational efforts and evaluation  of outcomes. Appendix III: Objectives, Scope, and Methodology

This report (1) describes recent national trends in prescription pain  reliever abuse and misuse, (2) describes how federal agencies are  educating prescribers about prescription pain reliever abuse and misuse,  (3) assesses the extent to which federal agencies follow key practices for  developing public education efforts about prescription pain reliever abuse  and misuse, and (4) identifies educational efforts that use similar  strategies and assess how agencies coordinate those efforts. To describe recent national trends in prescription pain reliever abuse and  misuse, we interviewed officials from the Centers for Disease Control and  Prevention (CDC), DEA, FDA, the National Institutes of Health’s (NIH)  National Institute on Drug Abuse (NIDA), the Office of National Drug  Control Policy (ONDCP), and the Substance Abuse and Mental Health  Services Administration (SAMHSA).
Why GAO Did This Study

The Centers for Disease Control and Prevention has declared that the United States is in the midst of an epidemic of prescription drug overdose deaths, with deaths associated with prescription pain relievers of particular concern. To address this issue, federal agencies are raising awareness by educating prescribers and the general public. In response to your request, GAO (1) described recent national trends in prescription pain reliever abuse and misuse, (2) described how federal agencies are educating prescribers, (3) assessed the extent to which federal agencies follow key practices for developing public education efforts, and (4) identified educational efforts that use similar strategies and assessed how agencies coordinate those efforts.
GAO interviewed officials and reviewed documents and websites from seven agencies involved in federal drug control efforts and analyzed the most recent data from several data sources related to prescription pain reliever abuse and misuse. GAO also assessed the development of public education efforts and federal coordination efforts against key practices from prior GAO work.

What GAO Found

Key measures of prescription pain reliever abuse and misuse increased from 2003 to 2009. The largest increases were in measures of adverse health consequences such as emergency department visits, substance abuse treatment admissions, and unintentional overdose deaths, though increases were not consistent across all measures. Federal officials suggested that increasing availability of prescription pain relievers and high-risk behaviors by those who abuse or misuse the drugs, such as combining prescription pain relievers with other drugs or alcohol, likely contributed to the rise in adverse health consequences, though data about the reasons for the increases are limited.
The Food and Drug Administration (FDA), the National Institutes of Health (NIH), and the Substance Abuse and Mental Health Services Administration (SAMHSA) use a variety of strategies to educate prescribers about issues related to prescription pain reliever abuse and misuse, but officials told us that more education is needed. The strategies used include developing continuing medical education programs, requiring training and certification in order to prescribe certain drugs, and developing curriculum resources for future prescribers. The Office of National Drug Control Policy (ONDCP) is working to develop a legislative proposal to require education for prescribers registering with the Drug Enforcement Administration (DEA) to prescribe controlled substances. Officials from some agencies said such a requirement would ensure all prescribers were starting from the same baseline of knowledge.
In their efforts to educate the public about prescription pain reliever abuse and misuse, DEA, FDA, NIH, ONDCP, and SAMHSA used almost all of the key practices for developing their consumer education efforts. Agencies varied in how they used the key practices when developing these efforts, which varied in size, scope, and duration. All agencies established metrics to monitor the implementation and functional elements of their educational efforts, but only two agencies have established or are planning to establish metrics to assess the impact of their efforts on audiences knowledge, attitudes, and behavior. Without outcome evaluations, federal agencies have limited knowledge of how effective their efforts are in achieving their goalsin this case, reducing prescription pain reliever abuse and misuse.
Among federal initiatives to educate prescribers and the public about prescription pain reliever abuse and misuse, GAO found several instances of agencies engaging in similar efforts, directed at similar target audiences and using similar mediums. Officials said that these similarities in public education efforts are beneficial in addressing prescription drug abuse and misuse because having multiple, reinforcing messages about the same subject is valuable in public health communications and because federal agencies provide slightly different perspectives on the issues surrounding prescription drug abuse and misuse. Likewise, the prescriber education programs GAO identified, though similar, are different in content and focus. Though these similar programs have the potential to be duplicative if not effectively coordinated, federal agencies have recently begun to coordinate their educational efforts. Nevertheless, federal agencies have missed opportunities to share lessons learned and pool resources among similar education efforts.

What GAO Recommends

GAO recommends that the Director of ONDCP establish outcome metrics and implement a plan to evaluate proposed educational efforts, and ensure that agencies share lessons learned among similar efforts. ONDCP did not explicitly agree or disagree with GAOs recommendations, but noted that it will continue to work for improved coordination of educational efforts and evaluation of outcomes.