PDMP & Opioid Abuse News

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.

Always check the medical record… and a prescription drug monitoring database.

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.

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.

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

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.

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.

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.

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

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.

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.

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.

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%.

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.

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.