Medscape’s Robert Lowes recently published an article detailing opioids’ prominent role in medication malpractice claims. Much of the press around the opioid crisis covers the deaths, hospitalizations, and substance use disorder problems. All of these can...
Route 50 talks about the importance of maps in telling the story of the opioid epidemic and how it can help public officials in particular drive home the point. Sometimes a picture is worth far more than 1,000 words. One of the challenges I see is the huge amount of...
Here is an example of the Board of Medical Examiners using PDMP history in the complaint process resulting in the practice shutting down. The record of PDMP checks is there, and a few states are starting to look at their mandated use requirements and the gaps between...
BMJ recently published an analysis of opioid prescribing among Medicare patients -“Opioid prescribering by multiple providers in Medicare: retrospective observational study of insurance claims”. A couple of things jumped out: Just over two thirds of opioid...
Dr. Vivek H. Murthy, our Surgeon General, recently released a report that, among other things, highlights the gap between the widespread substance use disorder problems the country faces and the relatively small amount of abuse treatment. Here’s an excerpt from...
Governor Chris Christie signed a bill on July 20th, 2015 requiring drug prescribers and pharmacists in NJ to register for the state’s Prescription Monitoring Program (PMP) and to check the PMP when prescribing controlled substances. “We’re not only...
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
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
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.
American Academy of Orthopaedic Surgeons, Now, March 2014
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.
Presentation by the Dir., Div. of Epidemiology NIH, National Institute on Drug Abuse, May 2013
Use of a state PDMP may help identify patients who are at high risk for diversion or doctor shopping… To quantify the effects of PDMPs, studies were conducted of ED providers who cared for adult patients with pain. Of the patients with complete data in one study, information from the state’s PDMP System altered prescribing practice in 41%.
ACEP - Annals of Emergency Medicine - 525
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
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
An improved PDMP … with accurate and timely data analysis should be regarded as the cornerstone of our collective efforts to address prescription drug abuse.
Department of Public Health
The use of PDMPs…is helping to reduce misuse of prescription drugs.
PDMP Center of Excellence at Brandeis University, February 2014 Briefing
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.
Pain Management / Clinical PolicyACEP Annals of Emergency Medicine 525, October 2012
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