Main Category: Pain / Anesthetics
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Article Date: 01 Jun 2012 - 0:00 PDT Current ratings for:
Researcher Calls For Expansion Of Programs To Identify Potential Drug Abusers And Protect Pain Patients
Individual use of prescription opioids has increased four-fold since the mid-1990s, in part due to increased awareness of pain control for chronic conditions such as low back pain and fibromyalgia and a Joint Commission mandate that hospitals assess patients' pain as a "vital sign" along with their blood pressure and temperature. During the same timeframe, however, the number of people using these drugs recreationally, becoming addicted to them, and dying of overdoses has also shot up. Today, nearly three quarters of all fatal drug overdoses in the United States are due to prescription drugs - far outnumbering deaths from cocaine and heroin combined, and often outpacing car accidents as the top cause of preventable deaths.
A Perspective piece published online in the New England Journal of Medicine outlines a plan for an "ideal" prescription-drug monitoring program that would enable doctors, dentists, pharmacists, researchers and law enforcement officials to access real-time data on patients' prescription drug histories. The authors, medical toxicologists Jeanmarie Perrone, MD, an associate professor of Emergency Medicine in the Perelman School of Medicine at the University of Pennsylvania, and Lewis S. Nelson, MD, a professor of Emergency Medicine at the New York University School of Medicine, say that such programs would allow physicians to take better care of patients with legitimate pain issues as well as identify and intervene to help potential drug abusers, and cut the number of opioids in circulation for illegal sale.
"As the number of deaths associated with prescription-drug use surpasses the number of fatalities from motor-vehicle crashes in many states, we can learn from the success of auto-safety innovations that have mitigated mortality despite increased automobile use over the past three decades," the authors write. "We should initiate active safety measures to address the growing rates of illness and death associated with the pharmaceuticalization of the 21st century."
The idea of state-run prescription-drug monitoring programs dates back to federal legislation authored in 1993 - long before robust internet use and the development of electronic medical records or e-prescribing systems. Today, 42 states have programs, another six have enacted legislation to develop them, and federal agencies including the Centers for Disease Control and Prevention and the Food and Drug Administration have called for broadening the efforts. But clinician awareness about the tools is poor, and some states, including Pennsylvania, restrict physician access, opening the databases only to law enforcement officials.
The authors note that mounting attention regarding abuse potential of painkillers such as oxycodone and hydrocodone has impaired physician-patient relationships in cases of genuine chronic pain issues. For instance, some recommendations suggest obtaining samples from patients for urine drug screens, or asking them to sign so-called "pain contracts" in which they must agree not to sell or give their drugs away.
To avoid these unintended consequences and improve opportunities to identify and help drug abusers, Perrone and Nelson call for a drug-monitoring system to better inform physician prescribing. Among their recommendations: standardization of the type of information submitted to the databases, and a move toward the use of bar-coded prescription paper to more quickly log entries, or a robust e-prescribing system that would eliminate paper and the resulting prescription fraud and "doctor shopping" that contributes to illicit use of these controlled substances. They also suggest that the programs include tracking of drugs ranging from those with the most potential for abuse and addiction (oxycodone, for instance) to codeine cough suppressants and stimulant drugs that may be sold or misused for cognitive enhancement.
The authors cite several benefits to more robust drug-monitoring program, including the potential to provide clinicians with an early warning that a patient may need drug counseling or treatment -- and an opportunity to intervene while the patient is still in the medical setting. In addition, they believe these programs could help identify patients who are receiving multiple legitimate prescriptions from different prescribers and pharmacies and may be at risk of polypharmacy complications. As an added benefit, they note that prescribers could use the databases to monitor use of their own Drug Enforcement Administration number to detect forged or stolen prescriptions.
"Although updating an existing prescription-drug monitoring database to incorporate these 'ideal' goals would require additional support and money, the potential to protect the public health is substantial," Perrone says.
Perrone and Nelson will speak this week at the Harold Rogers Prescription Drug Monitoring Program National Meeting in Washington, D.C., where lawmakers will convene to discuss ways to make existing prescription-drug monitoring programs more user-friendly and compliant with health care privacy laws, and strategies to ensure that the data can be shared between states.
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18 Nov. 2012.
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posted by No more pain clinic on 24 Aug 2012 at 12:44 pm
Memory of pain caused by injury remained in the brain and it will infact increases the pain sensation substantially .
The patient with pain must be screened by professionals to measure the level of actual pain. By doing such important measurement , the over used drug will be controlled .
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posted by michael wagner on 16 Jul 2012 at 3:18 pm
I believe this is correct:
In My case in the state of Wa. I thought with the new law here That I had to go to a pain specialist, well I do not have to as this law was misused to beniffit the Dr's in the pain and ESI's . I was on a very high amount, and due to the cost i asked my pain specialist if they would reduce my medication due to cost only.
Then again I aked to try another type that was cheaper, but I have been punished for trying one as I had severe side effects, Now I have been dropped 80 % from the time I started with this pain Place. Now I suffer daily, with severe spine problems including arachnoiditis and severe spinal stenios and have had 20 surgerys.
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posted by maryann Lawrence on 20 Jun 2012 at 1:25 pm
When REAL PEOPLE with REAL PAIN conditions have pain they have to suffer due to those who want to make $$$ in illegal sales or to get high. I tell people if I was an animal they would put me out of my misery. I dont even ask for pain meds anymore. I know all about the POTENTIAL for ABUSE or DEPENDENCY. I would trade it all for one day to be pain free. Anything that aids Chronic Pain Patients/ Sufferers live a better quality of life I'm all for it. Do what you must, but the practice of Doctors withholding pain meds is an epidemic. Even my 87 year old mother was denied pain meds until the last weeks of her life. How many people have ended their own lives because some kid down the street is snorting Oxycodone for the buzz. Sorry, Hit a sore spot with me and all I have is Tylenol to take for it.
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posted by Mark Gable on 20 Jun 2012 at 10:49 am
I wholeheartedly agree with this article. But, like an earlier opinion I think the police should be omitted unless the physician brings them in for specific situations. As a chronic pain sufferer I am tired of being the one who suffers because others choose to abuse these medications. I am behind anything that will keep these drugs out of the hands of those who misuse them and still allows pain sufferers to receive the medications needed to treat their pain!
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posted by Tony on 20 Jun 2012 at 6:43 am
The database idea presented would make a lot of sense if the police were eliminnated. Why involve law enforcement for a medical issue, this is actually a violation to a patient's expectation of privacy and also most likely a violation of the Constitution. Doing something for medical reasons to assist a patient is admirable - opening them up to harrassment is aborable. I can clearly see true pain patients being harrassed by police, being pulled over in their vehicles,having their homes invaded for useless searches, etc. Keep the police and all forms of law enforcement out and you have a good idea.
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posted by Brenda on 1 Jun 2012 at 1:07 pm
I think to allow physicians into the database will help them be able to control how much actual prescribtion drugs they give out and of course this will also help the ilegal giving of opids by physicians who tend to forget what a physician actually means.
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'Researcher Calls For Expansion Of Programs To Identify Potential Drug Abusers And Protect Pain Patients'
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