Prescription Advisory

Prescription Drug Epidemic

Overdose of prescription medicine is the #1 cause of accidental death in the US. Prescription drug overdose kills more people than automobile accidents or gun deaths.

The Center for Disease Control describes this as an epidemic and the LA Times reports “an estimated 52 million Americans use prescription drugs for nonmedical reasons as least once in their lifetimes” – that’s more than 1 in 7 in the US!

The American Academy of Pain Medicine says 100 million Americans suffer from chronic pain. It’s everywhere.

Prescription Advisory

Prescription Advisory was founded by a physician who developed protocols to deal with this epidemic and a software CEO. We created software so any practitioner could easily use these protocols to help their patients and better manage this epidemic.

We believe physicians, patients, prescribers, and dispensers all benefit from a clearer, more convenient picture of what’s going on. We make it automatic to check for a variety of risks and bring these to your attention before you sit down with your patient.

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

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

The use of PDMPs…is helping to reduce misuse of prescription drugs.

PDMP Center of Excellence at Brandeis University, February 2014 Briefing

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.

National Center for Health Statistics/CDC

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

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

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

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.

American Psychological Association

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.

American Psychological Association

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

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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

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.

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

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

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

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

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

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 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.

National Center for Health Statistics/CDC

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.

Editorial Pain Medicine, The American Academy of Pain Medicine; 2011;12:845

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