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...
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
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
You’re not only reducing the supply [of pain medications] for those who use them inappropriately, but also for those in need.
Bob Tillman – Director of Policy and AdvocacyAmerican Academy of Pain Management
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.
ACEP Annals of Emergency Medicine 525
The use of PDMPs…is helping to reduce misuse of prescription drugs.
PDMP Center of Excellence at Brandeis University, February 2014 Briefing
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
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
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.
Substance Abuse & Mental Health Services AdministrationOffice of the National Coordinator for Health IT, & MITRE Corp
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 f…
Editorial Pain Medicine, The American Academy of Pain Medicine; 2011;12:845
Emergency Physicians must balance under-treatment of pain with concerns about drug diversion and doctor shopping. Use of a state PDMP may help identify patients who are at high risk for prescription opioid 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%. Knowledge of the i…
ACEP - Annals of Emergency Medicine – 525
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