PastRx Resource Library

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.

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.

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…

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%.

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.

An improved PDMP … with accurate and timely data analysis should be regarded as the cornerstone of our collective efforts to address prescription drug abuse.

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.

 

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