Commentary in response to Paulozzi <i>et al.</i>: prescription drug abuse and safe pain management

Fishman, Scott M.

doi:10.1002/pds.1292

Cited by 15 publications

(17 citation statements)

References 13 publications

(26 reference statements)

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“…However, these statistics should be assessed cautiously. When physicians perceive difficulty in prescribing an agent, they are less likely to use it -even if it is the most efficacious and potentially beneficial treatment option 137 . Furthermore, reductions in prescription rates do not necessarily reflect a reduction in abuse rates.…”

Section: Patient Selectionmentioning

confidence: 98%

Rethinking the role of opioids in the outpatient management of chronic nonmalignant pain

Provenzano

Viscusi

2014

Current Medical Research and Opinion

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Appropriate patient selection through identification of risk factors, urine drug testing, and access to prescription monitoring programs has been shown to effectively improve care. Structured opioid therapy in a multimodal platform, including use of a low initial dose, prescription of alternative non-opioid analgesics including non-steroidal anti-inflammatory drugs and acetaminophen, as well as development of written care agreements to individualize and guide therapy has also been shown to improve patient outcomes. Implementation of opioid allocation strategies has the potential to encourage appropriate opioid use and improve patient care.

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Section: Patient Selectionmentioning

confidence: 98%

Rethinking the role of opioids in the outpatient management of chronic nonmalignant pain

Provenzano

Viscusi

2014

Current Medical Research and Opinion

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“…17,54,55 High-profile criminal prosecutions, coupled with shifts in DEA controlled substance prescribing policies, can convey an intimidating message to responsible physicians. 12,58 In several cases, prosecutors claimed that physicians should have known that individuals were feigning pain solely to obtain prescriptions, although deception is difficult to detect, even by conscientious physicians. 55,58 Many states have adopted policies to reassure licensees by recognizing that controlled substances are necessary for public health and that pain management is part of quality medical practice.…”

Section: Risks For Physicians Prescribing Opioidsmentioning

confidence: 99%

“…47 Studies highlighting the problem of prescription drug abuse often fail to consider the full context in which diversion can occur. 11,12 Many simplistically assume that the growing diversion and prescription drug abuse problem rests largely with prescribers and their patients because of increased opioid prescribing to address the public health problem of undertreated pain. 11,12,48 For example, according to the White House 2007 National Drug Control Strategy: 49 .…”

Section: Source Of Diverted Drugsmentioning

confidence: 99%

“…10 Some researchers and commentators have correlated the increase in deaths from opioids with the increase in legitimate prescribing of opioid analgesics for pain, but there is no direct evidence that one is exclusively driving the other, and many factors may be involved. 1,[11][12][13][14][15] The legal and regulatory environment surrounding the prescribing of opioids for chronic pain is in flux. 16 As prescribers of potentially abusable drugs, physicians have substantial risk management obligations.…”

Section: Introductionmentioning

confidence: 99%

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Pain Management with Opioid Analgesics

Stanos

Fishbain

Fishman

2009

American Journal of Physical Medicine &Amp; Rehabilitation

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“…While most physicians would be expected to support interventions to prevent fraudulent prescribing, high profile criminal prosecutions of physicians prescribing large amounts of opioids in USA [9,10] could make the physicians reluctant to prescribe controlled substances for fear of legal retribution (“chilling effect”) [1]. Although formal research on the chilling effect is rare, surveys indicate that some prescribers underutilise controlled substances due to fear of legal repercussions [11-13].…”

Section: Introductionmentioning

confidence: 99%

An inevitable wave of prescription drug monitoring programs in the context of prescription opioids: pros, cons and tensions

Islam

McRae

2014

BMC Pharmacol Toxicol

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BackgroundIn an effort to control non-medical use and/or medical abuse of prescription drugs, particularly prescription opioids, electronic prescription drug monitoring programs (PDMP) have been introduced in North-American countries, Australia and some parts of Europe. Paradoxically, there are simultaneous pressures to increase opioid prescribing for the benefit of individual patients and to reduce it for the sake of public health, and this pressure warrants a delicate balance of appropriate therapeutic uses of these drugs with the risk of developing dependence. This article discusses pros and cons of PDMP in reducing diversion of prescription opioids, without hampering access to those medications for those with genuine needs, and highlights tensions around PDMP implementation.DiscussionPDMPs may help alleviate diversion, over-prescription and fraudulent prescribing/dispensing; prompt drug treatment referrals; avoid awkward drug urine test; and inform spatial changes in prescribing practices and help designing tailored interventions. Fear of legal retribution, privacy and data security, potential confusion about addiction and pseudo-addiction, and potential undue pressure of detecting misuse/diversion - are the major problems. There are tensions about unintended consequence of excessive regulatory enforcements, corresponding collateral damages particularly about inadequate prescribing for patients with genuine needs, and mandatory consultation requirements of PDMP.SummaryIn this era of information technology PDMP is likely to flourish and remain with us for a long time. A clear standard of practice against which physicians’ care will be judged may expedite the utilisation of PDMP. In addition, adequate training on addiction and pain management along with public awareness, point-of-supply data entry from pharmacy, point-of-care real-time access to data, increasing access to addiction treatment and appropriate regulatory enforcement preferably through healthcare administration, together, may help remove barriers to PDMP use.

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Commentary in response to Paulozzi et al.: prescription drug abuse and safe pain management

Cited by 15 publications

References 13 publications

Rethinking the role of opioids in the outpatient management of chronic nonmalignant pain

Rethinking the role of opioids in the outpatient management of chronic nonmalignant pain

Pain Management with Opioid Analgesics

An inevitable wave of prescription drug monitoring programs in the context of prescription opioids: pros, cons and tensions

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