Amelia Mangune

Posted Date

Jun 9, 2022, 10:31 AM

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The reduction in prescribing opioids is a tool for decreasing lawful supply (by limiting the indications for opioid prescription or otherwise reducing the number of patients having prescriptions) and reducing demand or genuine desire for using or misusing opioids (Phillips, Ford & Bonnie, 2017). Reduced prescribing based on the authors, can impact demand in two methods: first, by reducing patients' dependence on opioids to handle pain by satisfying their needs through other forms of pain management; second, by reducing the number of individuals who develop opioid use disorder (OUD) and increasing the incentive for treatment among patients with OUD. 

Phillips, Ford & Bonnie (2017) also wrote that the Prescription Drug Monitoring Programs (PDMPs), currently authorized by U.S. states (except Missouri, the District of Columbia, and Guam's U.S. territory), are statewide electronic databases developed to prevent the diversion and misuse of controlled substances. They require pharmacies and dispensing providers to indulge in central office data on prescribed and dispensed controlled substances (e.g., drug type, dose, amount dispensed), insurance/payment, and patient details. These data can be scrutinized for patterns in prescribing and dispensing. It monitors patterns, including identifying possible "doctor shoppers" (individuals who visit multiple prescribers or pharmacies to obtain numerous prescriptions), the need for treatment, unsafe drug combinations, and inappropriate provider prescribing practices. In addition, because PDMPs include virtually all data on prescriptions dispensed to a patient regardless of payment method, they allow for more complete monitoring than claims databases, which are only confined to details on payments for prescriptions within a specific network.

We have a clinical responsibility to monitor our patients to whom we prescribe controlled substances (Becker & Starrels, 2021). Based on the authors, as practitioners, we should adhere to the policies of our state boards in the United States. Experts recommend a "universal precautions" practice incorporating a standard prescribing and monitoring framework for all patients prescribed the medications that include:

• Establishing a transparent clinician-patient relationship.
• Recording in the patient's medical record.
• A medical history, including substance use and mental health.
• Physical examination.
• Medical decision-making, including review of benefit and harm.
• Plan of care.
• Frequent follow-up with standardized monitoring for benefit and harm. 
• Drug testing. 
• Use of prescription monitoring programs where available. 
• Discuss all planned monitoring strategies in the treatment agreement.

Prescription drug misuse happens along a spectrum of severity, from less severe behaviors (e.g., a single incident of a patient taking more than prescribed) to more severe behaviors (e.g., undisclosed prescription sources). Therefore, every provider's response should be proportionate to the behaviors' severity and pattern. Patients presumed of substance use disorder should be referred to and evaluated by an addiction specialist (Becker & Starrels, 2021).

References

Becker, W.C. & Starrels, J.L. (April 06, 2021). Prescription drug misuse: Epidemiology, prevention, identification, and management. UpToDate. https://www.uptodate.com/contents/prescription-drug-misuse-epidemiology-prevention-identification-and-management?search=opioid%20misuse&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1

Phillips, J.K., Ford, M.A. & Bonnie, R.J. (July 13, 2017). 5 Evidence on strategies for addressing the opioid epidemic. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK458653/