Pain Management and Prescription Monitoring

Abstract

Preventing diversion and abuse of prescription controlled substances while ensuring their availability for legitimate medical use is an important public health goal in the United States. In one approach to preventing and identifying drug diversion, 17 states have implemented prescription monitoring programs (PMPs) to monitor the prescribing of certain controlled substances. While PMPs are not intended to interfere with legitimate prescribing, some in the pain management community feel that they negatively affect prescribing for pain management. This article describes a collaborative project initiated by the Pain & Policy Studies Group that brought together regulatory and pain management representatives twice in 1998 to share perspectives and reconcile differing views on the effects of PMPs. The ultimate goals of this project are to provide accurate information to healthcare clinicians about PMPs, better define the balance between preventing drug diversion and providing pain management, and promote continued dialog and cooperation among the groups.

State policy affecting pain management: recent improvements and the positive impact of regulatory health policies

“…Studies have shown that the adoption of this requirement precedes a notable decline in the prescribing of those drugs being monitored and an increase in the prescribing of medications not monitored, even though the substituted drugs are in lower schedules and may not be clinically effective [37]. The requirement of governmentissued serialized prescription forms are being replaced by electronic prescription monitoring programs that do not mandate use of a special form, or requires a forgery-resistant prescription form for a greater selection of schedules, thus reducing the likelihood of "down scheduling" [38]. Criterion 15 clearly has the potential to stigmatize certain treatment options, thereby reducing a practitioner's flexibility to respond appropriately to an individual patient's care requirements.…”

Chronic non-malignant musculoskeletal pain in older adults: clinical issues and opioid intervention

“…Switching to another analgesic with an equianalgesic dose is another option. 94 From a patient's standpoint, constipation is often the most troublesome consequence of opioid therapy. 25 95 96 Do not wait until constipation occurs.…”

Danger in Your Pill Bottle?

“…In a paper published in 2000, however, Joranson and colleagues examined drug abuse-related emergency department admission data from the federal Substance Abuse and Mental Health Services Administrational Drug Abuse Warning Network (DAWN) and from the federal Drug Enforcement Administration Automation of Reports and Consolidated Orders System (AR-COS) reported in 1990 to 1996. 5 During this interval, medical use of morphine, fentanyl, oxycodone, and hydromorphone increased by 59%, 1168%, 23%, and 19%, respectively, but the number of prescription opioid abuse mentions in the DAWN data rose by 6.6% and the ratio of total opioid abuse mentions relative to total drug abuse mentions decreased from 5.1% to 3.8%. Gilson and colleagues followed up on this work in 2004, examining medical and nonmed-ical opioid use from 1997 to 2002.…”