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

Abstract

Social policies have evolved to address the associated concerns related to the public health crises of drug abuse and undertreated pain. Prescription monitoring programs (PMPs) have been used for many years in this effort but are undergoing re-evaluation and restructuring in light of changes in technology as well as changes in our understanding of the collateral impact of such programs. We reviewed the state of PMPs in the United States and highlighted recent changes in these programs that have occurred nationally. The current changes occurring in California, with the most physicians of any U.S. state as well as the oldest triplicate-based serialized prescription program, are reviewed, with focus on the transition to tamper-resistant prescriptions that use security paper forms. Future trends for PMPs are described, including the potential for widespread use of electronic prescribing, which is gaining favor with the Drug Enforcement Agency.

Prescribing of opioid analgesics and related mortality before and after the introduction of long-acting oxycodone

“…26 In addition to a general increase in awareness, several specific interventions may help reduce the adverse health consequences of opioid prescribing. Real-time electronic databases accessible to physicians and pharmacists would make it more difficult for individuals to surreptitiously obtain opioids from multiple prescribers or pharmacies 30 and might reduce the risk of drug interactions between opioids and other central nervous system depressants. 31 Prescribers and pharmacists need to be better educated about the relative potency of different opioids, the use of physician-patient contracts in opioid prescribing, 32−34 the outpatient care of opioid-dependent individuals 35,36 and the potential interaction of opioids with other central nervous system depressants.…”

Collaboration or Coercion? Partnering to Divert Prescription Opioid Medications

“…[24][25][26] Recent attention to abuse and diversion of prescription opioids and criminalization of overprescribing may have a real or perceived "chilling effect" on the part of providers and pharmacists to write and fill these prescriptions. [27][28][29] Opioid drugs are vitally important medications for the treatment of pain, opioid dependence, and endstage disease. Growing awareness of abuse and diversion should not limit availability of these critical medications to patients in need.…”

Chronic Opioid Therapy and Preventive Services in Rural Primary Care: An Oregon Rural Practice-based Research Network Study

“…21,27,28,[30][31][32][33] These concerns may complicate clinical decision making regarding the prescription of opioids 34,35 and may result in extra time demands, failures in the patient-physician relationship, and less time on other activities. 7,26 Clinicians are increasingly under time constraints during offi ce visits, and it is reasonable to consider that time-consuming activities related to prescribing opioids may detract from other aspects of clinical care, including preventive services.…”