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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.
Qualitative data were collected through online focus groups and telephone interviews.
Pain Medicine, Volume 15, Issue 7, July 2014
A study was conducted to estimate the societal costs of prescription opioid abuse, dependence, and misuse in the United States. Costs were grouped into three categories: health care, workplace, and criminal justice.
The results: Total US societal costs of prescription opioid abuse were estimated at $55.7 billion in 2007 (USD in 2009). Workplace costs accounted for $25.6 billion, health care costs accounted for $25.0 billion, and criminal justice costs accounted for $5.1 billion. Workplace…
Pain Medicine, Volume 12, Issue 4, April 2011
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
Neurology, 2014; 83; 1277-1284, September 2014
The CDC advises providers to use PDMPs… States should consider ways to increase their use … available real-time, and alerts to prescribers.
Center for Disease Control and Prevention
In 2012, both New York and Tennessee required prescribers to check their state’s PDMP before prescribing painkillers.
The results one year later:
New York realized a 75% drop and Tennessee a 36% drop in patients who were seeing multiple prescribers to obtain the same drugs.
PDMP [National] Center of Excellence at Brandeis U, 2014
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.
American Society of Addiction Medicine
The AAOS recommends the following tools, which have been shown to significantly reduce medication errors:
computerized physician order entry
computerized decision support systems
computerized monitoring of adverse drug events
high-risk drug protocols
Overdose deaths are “just the tip of the iceberg”: that for every death there are many more hospital treatment admissions, emergency room visits, people who abuse or are dependent on prescripti…
American Psychological Association
PDMPs have many limitations in their current format, including complex access issues, timeliness, and whether the data are presented to the physician automatically or require physician effort to retrieve.
ACEP - Annals of Emergency Medicine – 525
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.
American College of Physicians, Annals of Internal Medicine, 9 April 2013
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.
February 2013 American Academy of Pain Medicine
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