Twelve states have more opioid prescriptions than people
Not every state has seen an equal rise in opioid use. In Hawaii, doctors wrote 52 opioid prescriptions for every 100 people in 2012, the least of any state according to a 2014 CDC study. In Alabama, it was almost 143 prescriptions per 100 people, more than anywhere else.
In all, 12 states had more opioid prescriptions than people 2012:
- Alabama: 142.9 per 100 people
- Tennessee: 142.8
- West Virginia: 137.6
- Kentucky: 128.4
- Oklahoma: 127.8
- Mississippi: 120.3
- Louisiana: 118
- Arkansas: 115.8
- Indiana: 109.1
- Michigan: 107
- South Carolina: 101.8
- Ohio: 100.1
The CDC study found no obvious geographic pattern to high levels of opioid prescriptions. If anything, researchers suspect that the variation shows a lack of consensus among doctors about how much pain medication to prescribe. Further, research shows that higher rates of prescription drug use don’t necessarily lead to better health outcomes or patient satisfaction.
“In fact, “the report says, “high rates of use might produce worse outcomes.”
Follow Prescription Advisory
The CDC advises providers to use PDMPs… States should consider ways to increase their use … available real-time, and alerts to prescribers.
Whenever possible, orthopaedic surgeons should request and review old medical records and speak with the patient’s primary physician about past medication problems. Currently, states have Prescription Drug Monitoring Programs designed to assist law enforcement in the identification of doctor shoppers; these data are also accessible to physicians.
Doctors (and other clinicians) need to know what prescriptions have been given to their patients by other practitioners. This information should be included in the patients’ electronic health care records accessible through a Prescription Drug Monitoring Program (PDMP) that provides immediate information.
When a clinician is prescribing a controlled substance, readily available information about the drugs that a patient is receiving from other providers can be a critically important component of the decision-making process…Increasingly, these [PDMP] programs have evolved into a useful tool for the clinician who must incorporate careful risk management into the prescribing of opioid analgesics or any other controlled substance.
Increasingly, these programs have evolved into a useful tool for the clinician who must incorporate careful risk management into the prescribing of opioid analgesics or any other controlled substance Prescription Drug Monitoring Programs Serve a Vital Clinical Need.
Effective monitoring systems [PDMPs] will augment clinical judgment, provide evidence of misuse, and facilitate prescription of the most appropriate analgesic for the situation…The Emergency Department is regarded as the nation’s safety net…the last bastion of around-the-clock access to care … Unfortunately, some of the solutions to opioid misuse [limiting ED physicians to 3-day opioid prescriptions] preempts judgments from trained emergency medical providers.
What prescribers can do to safely and effectively use opioids for CNCP (includes the following)
- Screen for prior or current substance abuse/misuse
- Do not use concomitant sedative–hypnotics or benzodiazepines
- Track daily MED using an online dosing calculator
- Use the state Prescription Drug Monitoring Program to monitor all sources of controlled substances
Recommendations for full use of PDMP include:
- PDMPs can be effective clinical tools in medication management involving controlled substances.
- PDMPs should be available for clinicians across state boundaries.
- Every prescribing clinician should be familiar with the process of accessing and utilizing information from PDMP’s so that they can incorporate this information in their practices.
You’re not only reducing the supply [of pain medications] for those who use them inappropriately, but also for those in need.
Attention to patterns of prescription requests and the prescribing of opioids as part of an ongoing relationship between a patient and a healthcare provider can decrease the risk of diversion. Periodic review of state PDMP, where available, is also a useful tool to monitor compliance. Evaluation should initially include…a drug history… Documentation is essential.
Thirteen multi-state PDMP projects were sponsored in 2012-13. While providers indicated that PDMPs gave them more confidence for prescribing pain medication, the study concluded that the easier the data is to obtain, the more they will be used, and the safer the practice can be.
Although relieving pain and reducing suffering are primary emergency physician responsibilities, there is a concurrent duty to limit the personal and societal harm that can result from prescription drug misuse and abuse.
An improved PDMP … with accurate and timely data analysis should be regarded as the cornerstone of our collective efforts to address prescription drug abuse.
You’re not only reducing the supply [of pain medications] for those who use them inappropriately, but also for those in need.
Prescription drug monitoring programs (PDMPs) are now active in most states to assist clinicians in identifying potential controlled drug misuse, diversion, or excessive prescribing. Little is still known about the ways in which they are incorporated into workflow and clinical decision making, what barriers continue to exist, and how clinicians are sharing PDMP results with their patients.
Design
Qualitative data were collected through online focus groups and telephone interviews.Setting
Clinicians from pain management, emergency and family medicine, psychiatry/behavioral health, rehabilitation medicine, internal medicine and dentistry participated.Patients
Thirty-five clinicians from nine states participated.Methods
We conducted two online focus groups and seven telephone interviews. A multidisciplinary team then used a grounded theory approach coupled with an immersion–crystallization strategy for identifying key themes in the resulting transcripts.Results
Some participants, mainly from pain clinics, reported checking the PDMP with every patient, every time. Others checked only for new patients, for new opioid prescriptions, or for patients for whom they suspected abuse. Participants described varied approaches to sharing PDMP information with patients, including openly discussing potential addiction or safety concerns, avoiding discussion altogether, and approaching discussion confrontationally. Participants described patient anger or denial as a common response and noted the role of patient satisfaction surveys as an influence on prescribing.Conclusion
Routines for accessing PDMP data and how clinicians respond to it vary widely. As PDMP use becomes more widespread, it will be important to understand what approaches are most effective for identifying and addressing unsafe medication use.
The use of PDMPs…is helping to reduce misuse of prescription drugs.
What prescribers can do to safely and effectively use opioids for CNCP (includes the following)
- Screen for prior or current substance abuse/misuse
- Do not use concomitant sedative–hypnotics or benzodiazepines
- Track daily MED using an online dosing calculator
- Use the state Prescription Drug Monitoring Program to monitor all sources of controlled substances
Always check the medical record… and a prescription drug monitoring database.
Effective monitoring systems [PDMPs] will augment clinical judgment, provide evidence of misuse, and facilitate prescription of the most appropriate analgesic for the situation…The Emergency Department is regarded as the nation’s safety net…the last bastion of around-the-clock access to care … Unfortunately, some of the solutions to opioid misuse [limiting ED physicians to 3-day opioid prescriptions] preempts judgments from trained emergency medical providers.
Prescribing or dispensing to an abuser, diverter, misuser or ‘doctor shopper’ puts the provider, their practice and or institution, as well as the patients at high risk.
Although relieving pain and reducing suffering are primary emergency physician responsibilities, there is a concurrent duty to limit the personal and societal harm that can result from prescription drug misuse and abuse.
Whenever possible, orthopaedic surgeons should request and review old medical records and speak with the patient’s primary physician about past medication problems. Currently, states have Prescription Drug Monitoring Programs designed to assist law enforcement in the identification of doctor shoppers; these data are also accessible to physicians.
David is Prescription Advisory’s Chief Marketing Officer. Software startups are his passion.
He also serves as the Director of Startup Grind Princeton and a mentor for the Princeton University eLab.