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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.
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%.
The CDC advises providers to use PDMPs… States should consider ways to increase their use … available real-time, and alerts to prescribers.
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.
You’re not only reducing the supply [of pain medications] for those who use them inappropriately, but also for those in need.
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.
Always check the medical record… and a prescription drug monitoring database.
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.
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.
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 costs were driven by lost earnings from premature death ($11.2 billion) and reduced compensation/lost employment ($7.9 billion).
Conclusions: The costs of prescription opioid abuse represent a substantial and growing economic burden for the society. The increasing prevalence of abuse suggests an even greater societal burden in the future.
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
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.
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 use of PDMPs…is helping to reduce misuse of prescription drugs.
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.
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 costs were driven by lost earnings from premature death ($11.2 billion) and reduced compensation/lost employment ($7.9 billion).
Conclusions: The costs of prescription opioid abuse represent a substantial and growing economic burden for the society. The increasing prevalence of abuse suggests an even greater societal burden in the future.
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.
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.
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%.
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.