Windmills and Pill Mills: Can PDMPs Tilt the Prescription Drug Epidemic?

Gugelmann, Hallam; Perrone, Jeanmarie; Nelson, Lewis S.

doi:10.1007/s13181-012-0273-8

Cited by 39 publications

(40 citation statements)

References 12 publications

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“…8,14 Prescription drug monitoring programs have been enacted in several states; although the impact of these programs has yet to be determined, there is evidence to suggest that they affect ED prescribing. 33,34 The areas we identified as having the largest share of opioid prescriptions (south, west, and urban areas) overlap with regions with high rates of nonmedical opioid use, although findings are somewhat inconsistent. 9,12,14,35 Although adequate pain management is important and the use of opioids is appropriate in many situations, providers must also be aware of the trends in opioid abuse and diversion and mitigate those risks.…”

Section: Discussionmentioning

confidence: 87%

Trends in Prescription Opioid Use in Pediatric Emergency Department Patients

Mazer‐Amirshahi¹,

Mullins²,

Rasooly³

et al. 2014

Pediatric Emergency Care

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Section: Discussionmentioning

confidence: 87%

Trends in Prescription Opioid Use in Pediatric Emergency Department Patients

Mazer‐Amirshahi¹,

Mullins²,

Rasooly³

et al. 2014

Pediatric Emergency Care

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“…Results suggest that substance users, sexual minorities, and those at extremes of the income distribution are more likely to engage in deception, but practitioners should only consider these factors as risks for deception, continuing to view and treat patients as individuals, as is ethically appropriate. The proliferation of prescription drug monitoring programs 13 will likely continue help reduce diversion via pill mills and "doctor shoppers," but they are not likely to identify situations where overprescribing is slight or infrequent. As such, legitimate physicians remain the front line and should equip themselves with every tool available, such as the presented profile of a deceiver, to limit their practice's contribution to the pharmaceutical diversion problem.…”

Section: Discussionmentioning

confidence: 99%

“…Unethical or irresponsible prescribing practices remain a leading contributor 11,12 ; "pill mills," pain clinics, and unethical employees of pharmacies are of particular concern. [12][13][14] However, most ethical physicians focused on their own practice are likely more concerned with the final form of drug diversionphysician deception. Physicians must be concerned that some patients are "doctor shopping" to obtain prescriptions from multiple physicians for a single malady 4,15 or that they are feigning or exaggerating symptoms to obtain a prescription for which they have no legitimate need.…”

mentioning

confidence: 99%

“…Unfortunately, this concern can negatively influence the regular practice of medicine because suspicions may lead to the undertreatment of pain in patients who are not feigning or exaggerating symptoms. 11,13 This study focused on physician deception, broadly defined as any dishonesty on the part of the patient directed at gaining access to pharmaceuticals (including complete fabrication of pain and symptoms, exaggeration of actual pain or symptoms, or attempts to obtain medications for an already treated illness). Physician deception includes patients attempting to gain access to an unneeded category of drugs, stronger doses, more dosages, or a stronger than needed pharmaceutical.…”

mentioning

confidence: 99%

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Deception for Drugs: Self-Reported "Doctor Shopping" Among Young Adults

Stogner

Sanders

Miller

2014

The Journal of the American Board of Family Medicine

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Background: Pharmaceutical abuse is a burgeoning problem, and various forms of drug diversion are becoming more common. At present, little is known about those who attempt to deceive physicians to receive medications, and even less is known about those who successfully avoid detection and abuse-related repercussions. The goal of this study is to assess the prevalence of attempted physician deception in a general population, explore common motives, and evaluate risk factors associated with the behavior.Methods: A stratified random sampling technique was used to obtain a locally representative sample of 2349 young adults. The sample was 48.4% male, 68.9% white, 24.4% black, and 2.8% Hispanic. Selected individuals were surveyed using a self-report instrument (80.4% response rate).Results: Of the respondents, 93 (4.0%) self-reported having attempted to deceive a physician to obtain a pharmaceutical. Most of these indicated that they were at least partially motivated by their own abuse. Approximately half reported that selling a portion of the prescription was a motivating factor. Alcohol use, marijuana use, and pharmaceutical misuse each were risk factors associated with attempted deception. Although no traits were definitively linked to the behavior, attempted deception was more commonly reported by men, Hispanics, self-identified lesbian/gay/bisexual/transgender individuals, and those at the lowest and highest extremes of the income spectrum. Logistic regression models of rare events indicated that past substance use along with sexual orientation and family income were related to attempted deception when controlling for other factors.Conclusion: Results suggest that attempted physician deception may be more common than previously believed. Practicing physicians should attempt to use risk factor information presented within this study, albeit very cautiously. This study identifies general characteristics of young people who might divert medications but notes that only a small minority of any patient group will do so. Awareness should not equal bias in the treatment of these patients; instead, it should reinforce the need for careful clinical interviewing and the utilization of prescription drug monitoring programs and local law enforcement databases. (J Am Board Fam Med 2014;27:583-593.)

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“…atomoxetine or guanfacine) can be considered [70]. Furthermore, to help physicians monitor for potential drug misuse prescription drug monitoring programs are available [71].…”

Section: Beyond Medicationmentioning

confidence: 99%

Aiming for remission in adults with attention-deficit/hyperactivity disorder: The primary care goal

Mattingly

Culpepper

Babcock

et al. 2015

Postgraduate Medicine

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Attention-deficit/hyperactivity disorder (ADHD) is often undiagnosed and undertreated in adults, resulting in wide-ranging problems and functional deficits in patients' lives. In addition, psychiatric comorbidities unrelated to symptom severity may be present. However, effective treatment that can alleviate symptoms and bring about meaningful improvements in functionality is available. Primary care providers can play a crucial role in recognizing and diagnosing ADHD, initiating and monitoring treatment, and obtaining consultations or arranging referrals when necessary, all with the goal of achieving and maintaining remission. Fulfillment of this role requires a practical understanding of the diverse clinical manifestations of ADHD in patients stratified by age and sex, and familiarity with current treatment guidelines. Although there is no absolute consensus on the criteria by which remission is defined, treatment response may be guided by objective ratings of global symptom severity and patients' self-reports of changes in their ability to cope with routine daily tasks, academic and vocational responsibilities, and social relationships. Although there has been much research into the genetic and neurophysiologic basis of ADHD, it is more important for primary care providers to appreciate that ADHD is a chronic condition requiring lifelong follow-up and that clinical presentation and response to treatment can vary widely among patients and over time in the same patients. Such variability makes the management of ADHD challenging, but the opportunity to bring about dramatic improvement in patients' lives makes it imperative for primary care providers to be competent in this area. This review provides primary care clinicians with a practical definition of remission in adults with ADHD, to emphasize that symptom reduction does not necessarily mean intact functionality, and to suggest a multidisciplinary approach aimed at achieving the greatest possible reduction of symptoms and normalization of functionality.

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Windmills and Pill Mills: Can PDMPs Tilt the Prescription Drug Epidemic?

Cited by 39 publications

References 12 publications

Trends in Prescription Opioid Use in Pediatric Emergency Department Patients

Trends in Prescription Opioid Use in Pediatric Emergency Department Patients

Deception for Drugs: Self-Reported "Doctor Shopping" Among Young Adults

Aiming for remission in adults with attention-deficit/hyperactivity disorder: The primary care goal

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