As the nation’s opioid crisis worsens, the authorities are confronting a resurgent, unruly player in the illicit trade of the deadly drugs, one that threatens to be even more formidable than the cartels.
The internet.
In a growing number of arrests and overdoses, law enforcement officials say, the drugs are being bought online. Internet sales have allowed powerful synthetic opioids such as fentanyl — the fastest-growing cause of overdoses nationwide — to reach living rooms in nearly every region of the country, as they arrive in small packages in the mail.
The authorities have been frustrated in their efforts to crack down on the trade because these sites generally exist on the so-called dark web, where buyers can visit anonymously using special browsers and make purchases with virtual currencies like Bitcoin.
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The CDC advises providers to use PDMPs… States should consider ways to increase their use … available real-time, and alerts to prescribers.
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.
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
- pharmacist-assisted rounds
- 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 prescription drugs and nonmedical users.
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.
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.
An improved PDMP … with accurate and timely data analysis should be regarded as the cornerstone of our collective efforts to address prescription drug abuse.
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 information provided had an important impact.
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.
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.
The abuse of opioid pain medication has a devastating impact on public health and safety in this country, killing 46 people every day… Prescription Drug poisoning deaths – now over 30,000/yr – outnumber deaths from motor vehicle crashes.
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 information provided had an important impact.
An improved PDMP … with accurate and timely data analysis should be regarded as the cornerstone of our collective efforts to address prescription drug abuse.
The CDC advises providers to use PDMPs… States should consider ways to increase their use … available real-time, and alerts to prescribers.
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
- pharmacist-assisted rounds
- 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 prescription drugs and nonmedical users.
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.
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.
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
- pharmacist-assisted rounds
- 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 prescription drugs and nonmedical users.
The use of PDMPs…is helping to reduce misuse of prescription drugs.
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.
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.
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.