Programs for monitoring inappropriate prescribing of controlled drugs: Evaluation and recommendations

Regulating Opioid Prescribing Through Prescription Monitoring Programs: Balancing Drug Diversion and Treatment of Pain

“…Gilson and Joranson found that medical regulators, most of whom were physicians, believed that the potential for regulatory scrutiny negatively impacted appropriate opioid prescribing [40]. No matter how clinically defensible, physicians fear that their prescribing patterns of these heavily regulated drugs will be intensely monitored by legal authorities [34,37,41]. A group of Wisconsin physicians were surveyed in 1991, and it was found that more than half the respondents at times reduced the drug dose or quantity of refills or prescribed a drug in a less‐regulated schedule in response to concerns of overzealous regulatory scrutiny [42,43].…”

“…The varieties of restrictions imposed upon controlled substances have created fear in both physicians and patients. PMPs are believed to have adverse effects on the legitimate prescribing of controlled substances, including the inappropriate substitution of nonregulated drugs [34,35]. Some physicians feel this way because they would rather not be bothered by the extra paperwork involved, while others fear that stocking special prescription pads leaves them open to being burglarized.…”

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

“…It is well established that when physicians are faced with barriers to prescribing a certain type of medication they will often prescribe around that barrier, turning to drugs that are perceived to be less scrutinized, even if they are less efficacious and/or more harmful. [5][6][7][8][9] This pattern is known as the substitution effect. 10 Implementation of some PMPs have been demonstrated to decrease the prescribing of Schedule II controlled substances and to stimulate reactionary aberrant prescribing patterns.…”

Risk of the View Through the Keyhole: There Is Much More to Physician Reactions to the DEA Than the Number of Formal Actions

“…This California experience should have been predicted as it is well established that when physicians are faced with barriers to prescribing a certain type of medication they will often prescribe around that barrier, turning to drugs that are perceived to be less scrutinized, even if they are less efficacious and/or potentially harmful [4–7]. This pattern is known as the substitution effect [3].…”