Prescription Opioids: Risk Management and Strategies for Safe Use _ _________________________________ monitors prescription drug abuse, misuse, and diversion [155].
• Prohibition from obtaining controlled substance prescriptions from multiple providers • Patient identification required before dispensing • Immunity from prosecution or mitigation at sentencing for individuals seeking assistance during an overdose UNINTENDED NEGATIVE CONSEQUENCES OF EFFORTS TO REDUCE PRESCRIBED OPIOID MISUSE, DIVERSION, AND OVERDOSE The United States is unquestionably experiencing serious substance abuse problems involving pre- scription opioids. Although efforts to curtail opioid analgesic prescribing and distribution have been well intentioned, several of the approaches have resulted
The DEA is responsible for formulating federal standards for the handling of controlled substances. In 2011, the DEA began requiring every state to implement electronic databases that track prescrib- ing habits, referred to as PDMPs. Specific policies regarding controlled substances are administered at the state level [156]. Almost all states have enacted PDMPs to facilitate the collection, analysis, and reporting of information on controlled substances prescribing and dispensing. Most PDMPs employ electronic data transfer systems that transmit prescription information from the dispensing pharmacy to a state agency [113]. The General Accounting Office evaluated the effi- cacy of PDMPs and concluded that such programs have the potential to help law enforcement and regu- latory agencies rapidly identify and investigate activi- ties that may involve illegal prescribing, dispensing, or consumption of controlled substances. In states that have made real-time data available, PDMPs can help reduce prescription drug abuse and diversion by allowing prescribers to access and detect whether a patient has been receiving multiple prescriptions for controlled substances or whether a patient has filled or refilled an order for a prescribed opioid [113]. However, several concerns over PDMPs were voiced around the time of their widespread introduction, including the risk that PDMPs may negatively affect patients with legitimate opioid need by reducing opioid prescribing, potential privacy issues, and more frequent physician visits [156]. REGULATIONS AND PROGRAMS AT THE STATE LEVEL Several regulations and programs at the state level have been enacted in an effort to reduce prescription opioid abuse, diversion, and overdose, including [157]: • Physical examination required prior to prescribing • Tamper-resistant prescription forms • Pain clinic regulatory oversight • Prescription limits
in unintended consequences. DIFFICULTY OBTAINING LEGITIMATE OPIOID ANALGESICS
Enactments of restrictive mandates to govern opioid analgesic prescribing and dispensing have created difficulty for patients in accessing legitimate opioid therapeutics. This has been especially well docu- mented in the state of Washington, but it is highly prevalent in general. Concerns have been voiced by numerous key opinion leaders and prominent individuals in the pain treatment profession and community in an effort to draw attention to regula- tory and law enforcement overreach at the expense of patients suffering in pain who require access to opioid analgesics. One example is Jan Chambers, president of the National Fibromyalgia and Chronic Pain Associa- tion (NFMCPA). For incorporation into a position paper on patient rights to access pain medication, Chambers sought input from members requiring prescribed opioids for their pain condition. In the open letter encouraging member input, Chambers expressed concern over federal law enforcement and regulatory overreach involving heightened scrutiny
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MDMS1526
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