Table 7. Drugs with Highest Potential for Diversion and Misuse
Drug Class
Examples
Anabolic Steroids
Methyltestosterone Testosterone
Depressants
Barbiturates: pentobarbital Benzodiazepines: alprazolam, diazepam
Hallucinogens
Ketamine
Opioids
Diphenoxylate Fentanyl Hydrocodone Hydromorphone Meperidine Methadone Morphine Oxycodone Oxymorphone
Stimulants
Amphetamine Dextroamphetamine Methamphetamine Methylphenidate
Centers for Medicare and Medicaid Services. Partners in Integrity: What is a Prescriber’s Role in Preventing the Diversion of Prescription Drugs? https://www. pharmacy.umn.edu/sites/pharmacy.umn.edu/files/ prescriber_role_in_preventing_diversion.pdf Accessed June 30, 2021.Distinguishing would-be diverters from patients is difficult at best. Although no behavior reliably indicates drug diversion, the chances of detecting such deception increase when HCPs watch for patterns of behavior. The DEA has listed some common behaviors that should not be considered an exhaustive list but that might indicate a person seen in-clinic is seeking drugs to divert or misuse: 24 ● Demanding to be seen immediately ● Stating that they are visiting the area and need a prescription to tide them over until seeing a local HCP ● Appearing to feign symptoms, such as abdominal or back pain or pain from kidney stones or a migraine to obtain opioids ● Claiming non-opioid analgesics do not work ● Requesting a particular opioid ● Complaining that a prescription has been lost or stolen and needs replacing ● Requesting more refills than originally prescribed ● Using pressure tactics or threatening behavior to obtain a prescription ● Showing visible signs of drug abuse, such as track marks
Clinical practices to minimize the potential diversion when seeing patients include: 25 ● Caution when prescribing to patients who request combinations of drugs that may enhance effects, such as opioids with benzodiazepines ● Thorough documentation when prescribing or choosing not to prescribe opioids ● Keeping a DEA registrant or license number confidential unless disclosure is required ● Protecting access to prescription pads ● Ensuring that prescriptions are written clearly to minimize the potential for forgery ● Moving to electronic prescribing so that paper prescriptions are not required ● Adhering to strict refill policies and educating office staff ● Using PDMPs in accordance with state regulation and expert guidance ● Referring patients with extensive pain management or prescription needs to specialists in relevant fields ● Collaborating with pharmacists and other providers to verify prescription authenticity and medical necessity ● Collaborating with pharmacy benefit managers and managed care plans that seek to determine medical necessity of prescriptionsPrescription drugs are also diverted by HCPs in various health care settings. 90 Medical professionals engage in diversion for myriad reasons that include recreation, an active SUD, financial gain, self-medication for pain or sleep, or to manage withdrawal symptoms. 25 Mismanagement of patients by HCPs can also happen because the HCPs were duped
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Book Code: TN24CME
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