[Federal Register Volume 82, Number 73 (Tuesday, April 18, 2017)]
[Notices]
[Pages 18300-18303]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2017-07821]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Food and Drug Administration
[Docket No. FDA-2017-N-1094]
Training Health Care Providers on Pain Management and Safe Use of
Opioid Analgesics--Exploring the Path Forward; Public Workshop; Request
for Comments
AGENCY: Food and Drug Administration, HHS.
ACTION: Notice of public workshop; request for comments.
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SUMMARY: As part of the work by the Federal Government to address the
epidemic of prescription and illicit opioid abuse, the Food and Drug
Administration (FDA, the Agency, or we) is announcing a public workshop
to obtain input on issues and challenges associated with Federal
efforts to support training on pain management and the safe
prescribing, dispensing, and patient use of opioids (safe use of
[[Page 18301]]
opioids) for health care providers. As discussed in this document, the
workshop has three main goals. First, participants will be asked to
discuss the role that health care provider training plays, within the
broader context of ongoing activities, to improve pain management and
the safe use of opioids. Second, participants will be asked to comment
on how best to provide health care providers, who prescribe or are
directly involved in the management or support of patients with pain,
appropriate training in pain management and the safe use of opioids.
Finally, participants will be asked about the issues and challenges
associated with possible changes to Federal efforts to educate health
care providers on pain management and the safe use of opioids.
Participants are expected to include individuals from a broad set
of Federal, State, and private stakeholder groups that are working on
the challenges of improving pain management while addressing the opioid
abuse epidemic. The Federal Agencies participating include FDA, the
Drug Enforcement Administration, the Department of Veterans Affairs,
the Centers for Disease Control and Prevention, the Department of
Defense, the Centers for Medicare & Medicaid Services, the National
Institute on Drug Abuse, and the Substance Abuse and Mental Health
Services Administration, and the Indian Health Service. Public
participation and comment are encouraged.
DATES: The public workshop will be held on May 9 and 10, 2017, from
8:30 a.m. to 5 p.m. Submit either electronic or written comments on
this public workshop by July 10, 2017. Late, untimely filed comments
will not be considered. Electronic comments must be submitted on or
before July 10, 2017. The https://www.regulations.gov electronic filing
system will accept comments until midnight Eastern Time at the end of
July 10, 2017. Comments received by mail/hand delivery/courier (for
written/paper submissions) will be considered timely if they are
postmarked or the delivery service acceptance receipt is on or before
that date. See the SUPPLEMENTARY INFORMATION section for registration
date and information.
ADDRESSES: The public workshop will be held at the Sheraton Silver
Spring Hotel, 8777 Georgia Ave., Silver Spring, MD 20910, 877-298-2066.
You may submit comments as follows:
Electronic Submissions
Submit electronic comments in the following way:
Federal eRulemaking Portal: https://www.regulations.gov.
Follow the instructions for submitting comments. Comments submitted
electronically, including attachments, to https://www.regulations.gov
will be posted to the docket unchanged. Because your comment will be
made public, you are solely responsible for ensuring that your comment
does not include any confidential information that you or a third party
may not wish to be posted, such as medical information, your or anyone
else's Social Security number, or confidential business information,
such as a manufacturing process. Please note that if you include your
name, contact information, or other information that identifies you in
the body of your comments, that information will be posted on https://www.regulations.gov.
If you want to submit a comment with confidential
information that you do not wish to be made available to the public,
submit the comment as a written/paper submission and in the manner
detailed (see ``Written/Paper Submissions'' and ``Instructions'').
Written/Paper Submissions
Submit written/paper submissions as follows:
Mail/Hand delivery/Courier (for written/paper
submissions): Division of Dockets Management (HFA-305), Food and Drug
Administration, 5630 Fishers Lane, Rm. 1061, Rockville, MD 20852.
For written/paper comments submitted to the Division of
Dockets Management, FDA will post your comment, as well as any
attachments, except for information submitted, marked and identified,
as confidential, if submitted as detailed in ``Instructions.''
Instructions: All submissions received must include the Docket No.
FDA-2017-N-1094 for ``Training Health Care Providers on Pain Management
and Safe Use of Opioid Analgesics --Exploring the Path Forward; Public
Workshop; Request for Comments.'' Received comments, those filed in a
timely manner (see DATES), will be placed in the docket and, except for
those submitted as ``Confidential Submissions,'' publicly viewable at
https://www.regulations.gov or at the Division of Dockets Management
between 9 a.m. and 4 p.m., Monday through Friday.
Confidential Submissions--To submit a comment with
confidential information that you do not wish to be made publicly
available, submit your comments only as a written/paper submission. You
should submit two copies total. One copy will include the information
you claim to be confidential with a heading or cover note that states
``THIS DOCUMENT CONTAINS CONFIDENTIAL INFORMATION.'' The Agency will
review this copy, including the claimed confidential information, in
its consideration of comments. The second copy, which will have the
claimed confidential information redacted/blacked out, will be
available for public viewing and posted on https://www.regulations.gov.
Submit both copies to the Division of Dockets Management. If you do not
wish your name and contact information to be made publicly available,
you can provide this information on the cover sheet and not in the body
of your comments and you must identify this information as
``confidential.'' Any information marked as ``confidential'' will not
be disclosed except in accordance with 21 CFR 10.20 and other
applicable disclosure law. For more information about FDA's posting of
comments to public dockets, see 80 FR 56469, September 18, 2015, or
access the information at: https://www.gpo.gov/fdsys/pkg/FR-2015-09-18/pdf/2015-23389.pdf.
Docket: For access to the docket to read background documents or
the electronic and written/paper comments received, go to https://www.regulations.gov and insert the docket number, found in brackets in
the heading of this document, into the ``Search'' box and follow the
prompts and/or go to the Division of Dockets Management, 5630 Fishers
Lane, rm. 1061, Rockville, MD 20852.
FOR FURTHER INFORMATION CONTACT: Mary Gross, Center for Drug Evaluation
and Research, Food and Drug Administration, 10903 New Hampshire Ave.,
Bldg. 51, Rm. 6178, Silver Spring, MD 20993-0002, 301-796-3519, email:
[email protected]; or Doris Auth, Center for Drug Evaluation and
Research, Food and Drug Administration, 10903 New Hampshire Ave., Bldg.
22, rm. 2480, Silver Spring, MD 20993-0002; 301-796-0487, email:
[email protected].
SUPPLEMENTARY INFORMATION:
I. Background
On July 12, 2012, FDA approved a risk evaluation and mitigation
strategy (REMS) for extended release (ER) and long-acting (LA) opioid
analgesic medications (ER/LA Opioid Analgesics REMS). The goal of such
REMS is to reduce serious adverse outcomes resulting from inappropriate
prescribing, misuse, and abuse of extended-release or long-acting (ER/
LA) opioid analgesics while maintaining patient access to pain
medications.
[[Page 18302]]
Adverse outcomes of concern include addiction, unintentional overdose,
and death. The ER/LA Opioid Analgesics REMS requires that prescriber
training in the form of accredited continuing education be made
available to health care providers who prescribe ER/LA opioid
analgesics.
On May 3 and 4, 2016, FDA convened a joint meeting of the Drug
Safety and Risk Management Advisory Committee and the Anesthetic and
Analgesic Drug Products Advisory Committee to discuss whether this REMS
assures safe use of these products, whether it is not unduly burdensome
to patient access to the drugs, and whether it (to the extent
practicable) minimizes the burden to the health care delivery system
(https://www.gpo.gov/fdsys/pkg/FR-2016-03-14/pdf/2016-05573.pdf). FDA
sought input on possible modifications to the ER/LA Opioid Analgesic
REMS, including expansion of the scope and content of prescriber
training and expansion of the REMS program to include immediate release
(IR) opioid analgesics. The majority of committee members were in favor
of modifying the REMS program to include the IR opioid analgesics as
well as broadening the training program to include pain management.
Though the majority of the committee members were in favor of a
requirement for all prescribers to complete training, they recommended
that the required training program be implemented through mechanisms
outside of the FDA REMS authority. The committees also stated that
other health care providers involved in the management of pain should
be included as a target audience for education, though they did not
specify that the training should be mandatory for non-prescribing
health care providers.
In addition to the joint Advisory Committee advice on prescriber
education, a Request for Information (RFI) was posted by the Department
of Health and Human Services (HHS) Assistant Secretary of Planning and
Education on July 8, 2016 (81 FR 44640), seeking comment on the most
promising approaches in prescriber education and training programs and
effective ways to leverage HHS programs to implement/expand them. The
2017 public workshop on May 9 and 10 seeks to build on one of the
requests outlined in that RFI, specifically, the request for
suggestions of additional activities HHS and its federal partners could
implement to support universal prescriber education on appropriate pain
management and opioid analgesic prescribing.
II. Topics for Discussion at the Public Workshop
On May 9 and 10, 2017, FDA on its own behalf and in conjunction
with the other participating federal agencies will hold a public
workshop and convene government experts, representatives from State
licensing boards, professional associations, health care systems,
patient groups, and other relevant stakeholder groups. The workshop has
three major goals. First, participants will be asked to discuss the
role that health care provider training plays, within the broader
context of ongoing activities, to improve pain management and the safe
use of opioids. Second, participants will be asked to comment on how
best to provide health care providers, who prescribe or are directly
involved in the management or support of patients with pain,
appropriate training in pain management and the safe use of opioids. As
a part of this discussion, current training efforts by States,
hospitals and health care systems, Federal Agencies, professional
associations and other groups will be considered in order to strategize
how best to facilitate training for these health care providers.
Finally, participants will also be asked about issues and challenges
associated with possible changes to Federal efforts to educate health
care providers on pain management and the safe use of opioids.
Participants include individuals from a broad set of Federal,
State, and private stakeholders that are working on the challenges of
improving pain management while addressing the opioid abuse epidemic.
The Federal Agencies participating include FDA, the Drug Enforcement
Administration, the Department of Veterans Affairs, the Centers for
Disease Control and Prevention, the Department of Defense, the Centers
for Medicare & Medicaid Services, the National Institute on Drug Abuse,
the Substance Abuse and Mental Health Services Administration, and the
Indian Health Service. Public participation and comment is encouraged.
Panels will be drawn from Federal and State agencies, as well as
other private and public groups working to address pain management and/
or opioid abuse. During the panel discussions, panelists will be asked
to address the following:
(1) The relative role of Federal training/education efforts in the
larger landscape of activities aimed at improving pain management,
including the use of opioid analgesics. This includes a discussion of
ongoing efforts being led by States, hospitals and health care systems,
other Federal Agencies, and medical societies that focus on other
aspects of the issue, such as Prescription Drug Monitoring Programs.
(2) The merits and challenges of utilizing Federal mechanisms to
provide education on pain management and the safe use of opioid
analgesics. This includes a discussion of the role, if any, of
mandatory Federal education efforts.
(3) The merits and challenges of utilizing non-Federal mechanisms
to provide education on pain management and the safe use of opioid
analgesics. This includes a discussion of current State and other
efforts and the role they are playing in training/education on pain
management and the safe use of opioid analgesics.
(4) The merits and challenges of utilizing partnerships between
Federal Agencies and other groups to provide education on pain
management and the safe use of opioid analgesics. This includes a
discussion of the role of the Federal Government in formal public-
private partnerships or other combined approaches to training/education
on pain management and the safe use of opioid analgesics for all
prescribers. It also includes a discussion of the appropriate
organizations (e.g., Federal Agency, State medical board, other) to
include in such efforts.
(5) The aspects of the opioid epidemic that can be most impacted by
the training of health care providers and how outcomes of these
training programs can be measured.
III. Participating in the Public Workshop
Registration: Persons interested in attending this public workshop
must register online by sending an email to https://nakamotoevents.wufoo.com/forms/p1gsrzm80gd7lkd/ before May 1, 2017.
Please provide complete contact information for each attendee,
including name, title, affiliation, address, email, and telephone.
Registration is free and based on space availability, with priority
given to early registrants. Persons interested in attending this public
workshop must register by May 1, 2017. Early registration is
recommended because seating is limited; therefore, FDA may limit the
number of participants from each organization. Registrants will receive
confirmation when their registration has been accepted. If time and
space permit, onsite registration on the day of the public workshop
will be provided beginning at 7:30 a.m.
If you need special accommodations due to a disability, please
contact Mary Gross or Doris Auth (see FOR FURTHER INFORMATION CONTACT)
no later than May 1, 2017.
[[Page 18303]]
Requests for Oral Comments: During online registration you may
indicate if you wish to provide a statement during the Open Public
Comment Period. We will do our best to accommodate requests to make
public comments based on time allocated for public comment. Individuals
and organizations with common interests are urged to consolidate or
coordinate their comments, and request time for a joint presentation.
Following the close of registration date, we will determine the amount
of time allotted to each commenter and the approximate time each oral
comment is scheduled to begin; commenters should arrive ahead of their
scheduled time in case the agenda moves ahead of schedule so as to be
sure not to forfeit their speaking time. All requests to make oral
comments must be received by the close of registration on May 1, 2017.
No commercial or promotional material will be permitted to be presented
or distributed at the public workshop.
Streaming Webcast of the Public Workshop: This public workshop will
also be Webcast. Additional information will be made available
regarding accessing the Webcast 2 days prior to the public workshop at
http://www.fda.gov/Drugs/NewsEvents/ucm538047.htm.
Transcripts: Please be advised that as soon as a transcript of the
public workshop is available, it will be accessible at https://www.regulations.gov. It may be viewed at the Division of Dockets
Management (see ADDRESSES). A link to the transcript will also be
available on the Internet at http://www.fda.gov/Drugs/NewsEvents/ucm538047.htm.
Dated: April 13, 2017.
Anna K. Abram,
Deputy Commissioner for Policy, Planning, Legislation, and Analysis.
[FR Doc. 2017-07821 Filed 4-17-17; 8:45 am]
BILLING CODE 4164-01-P