Many cases of prescription drug abuse involve people getting the drugs from a relative or friend. However, according to CDC researchers, individuals who are at a much higher risk of overdose are just as likely to have them prescribed to them by a doctor. In fact, many opioid pain reliever abusers do go straight to their doctors for their drugs.

In 2016, more than 84% of people in the U.S. were in contact with a healthcare professional. Because of this, physicians and other clinicians are placed in a position of identifying when prescription drugs are being abused and taking measures to prevent a patient’s abuse turning into a substance-use disorder.

While most individuals do take their prescription drugs responsibly, around 18 million people (6% aged 12 and older) abused their medications in 2017 at least once in the past year. The 2017 National Survey on Drug Use and Health results estimated around 2 million people in the U.S. abused prescription painkillers within the first year for the first time, averaging to around 5,480 a day.

Someone in the U.S. dies every 19 minutes from an accidental prescription drug overdose.

How Physicians Can Prevent Prescription Drug Abuse and Safeguard Patient Health

An essential part of patient care is preventing or stopping patients from misusing their prescription drugs (recreationally, nonmedical use). But, this doesn’t mean certain patients can’t benefit from certain prescription medications like opioid pain relievers, stimulants or sedatives. So, healthcare providers must balance out patients’ genuine needs for prescription medication with the possible risk of abuse. Some ways physicians can help prevent prescription drug abuse and safeguard their patients’ health are:

1. Talk with Patients

Healthcare providers can consult with their patients about the necessary steps they should take to ensure they’re using their prescription drugs properly. These steps may include:

• Following the instructions precisely given by the pharmacist or what’s printed on the label
• Knowing the possible interactions with other prescription medications, drugs or alcohol
• Never using other people’s prescription medications or giving others their prescription medications
• Never changing or stopping a dosage regimen without consulting with their healthcare provider first
• Storing prescription medications safely
• Discarding expired or unused prescription medications safely by following the guidelines set by the U.S. Food and Drug Administration (FDA) 

2. Check PDMPs Before Prescribing Prescriptions to Patients

Prescription drug monitoring programs (PDMPs) track controlled prescription medication prescribing and dispensing to patients. They’re state-run electronic databases and are essential tools to help prevent and identify prescription drug abuse. In some states, the use of PDMPs has been linked with a lower rate of opioid prescribing and overdose.

Physicians need to screen patients for possible abuse risk and check past records of state PDMPs so they can prescribe carefully and treat those who are troubled.

3. Seek Alternative Pain Solutions

Healthcare providers who prescribe prescription pain relievers need to become more knowledgeable about finding and treating pain with alternative pain solutions and coordinate the management of pain with complementary and integrative healthcare providers.

4. Screen for Potential Drug Abuse

Screening for potential prescription drug abuse is something physicians should be doing as well. Around two million people in the U.S. struggle with prescription drug addiction, according to the American Society of Addiction Medicine (ASAM). Healthcare providers should become knowledgeable with the most recent clinical information on prescription drug addiction signs.

They can help their patients recognize if an issue does exist by asking about all drugs. Then, they can offer them or refer them to the right treatment and set goals for recovery. They can incorporate evidence-based screening tools into their routine medical visits for nonmedical prescription drug use. They’ll want to be aware of a patient’s rapid increase in the frequency of unscheduled refill requests or amount of medication required. Healthcare providers should also be aware of the fact that individuals who misuse prescription drugs could be engaged in “doctor shopping” where they move from one doctor to the next in an attempt to obtain multiple prescriptions for their choice of drug.

5. Be Aware of How They’re Prescribing Medication

Clinicians should take note of their own prescribing behaviors which may potentially lead to possible abuse or misuse of highly addictive pain relievers like opioids. Clinicians can tap into health systems that are supporting physician efforts by offering clinical training on opioid alternatives for managing pain.

6. Preventing Inappropriate Prescribing and Medical Errors

Detecting medical errors and inappropriate prescribing of opioids and other addictive prescription drugs is an essential component of reducing the risk of abuse and misuse. This includes:

• Off-label use
• Inaccurate patient selection (i.e. opioid-naive patients)
• Incorrect dosage
• Inaccurate indication (i.e. “as needed” use of extended-release formulas)
• Conversion errors

This can be achieved by establishing algorithms designed for identifying mismatches between diagnoses and medicine/dosage. The purpose behind measures like this shouldn’t be to prosecute the prescribing healthcare providers (unless there’s clearly proven unlawful behavior), but rather to educate those who made honest, safe opioid prescribing practice errors and help prevent malpractice lawsuits.

Decreased medical errors and safe opioid prescribing could be better implemented by setting up systems (i.e. electronic prescribing) in healthcare provider offices.

The use of electronic prescribing in the U.S. for controlled substances was issued by the U.S Drug Enforcement Administration, approved and became effective on June 1, 2010. It’s expected to add another layer of protection against prescription drug abuse by reducing prescription forgery and the number of prescription errors due to illegible handwriting. It’s anticipated to take up to 18 months to implement this regulation because certain operational problems need to be resolved and there needs to be an update to prescribing software.

7. Involve Pharmacists

Not only can clinicians and physicians help prevent prescription medication abuse, but pharmacists play a big role as well by helping patients understand the directions on the labels of their medications so they take them properly. They also help patients understand how their particular medications work for their specific ailments. Along with this, pharmacists can be watchful for prescription alterations and falsifications and be front and center of defense in recognizing problematic prescription drug use patterns. 

Some pharmacies have hotlines designed to alert other pharmacies in their location when they identify fraudulent prescriptions. And, pharmacists can also use PDMPs, along with physicians, to help track patient prescribing and dispensing patterns.Physicians can accurately catalog and track all treatments and prescriptions with our Chartnote tool. Contact us to learn more information on how Chartnote works and how it can benefit your practice and ability to prevent prescription drug abuse in your patients.

Should primary care physicians stop prescribing controlled substances? What’s the role of the primary care physician to the solution of the opioid epidemic? Feel free to share in the comments section below.

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Posted on: July 30, 2021, by : Gerardo Guerra Bonilla