Prescription monitoring programs: Helpful or harmful?

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Prescription monitoring programs: Helpful or harmful?

Destruction opioid crisis is daily news, including stories on how to "fix it". Various initiatives have been proposed in an effort to prevent this epidemic and the damage it causes. The prescription monitoring program (PMP) is one of them. The goal of PMP is good - to identify patients prescribed some medications by some doctors. It is a means to introduce some stewardship to prevent overuse and abuse of prescription drugs.

How prescription monitoring programs work

The prescription monitoring program is a state-based electronic database that provides a way to track prescriptions, especially controlled substances including opioids, benzodiazepines, and amphetamines. They are intended to support access to the legitimate medical use of these drugs, and to help identify and prevent drug abuse and diversion (when drugs are not used by the people they prescribe). Currently 49 states, the District of Columbia, and Guam have PMPs, and in many countries providers must access PMP before prescribing controlled substances.

PMPs have had some successes, with some countries showing an overall decline in opioid overdose prescriptions after implementation. At the same time, there are some challenges that hinder the use of effective prescription monitoring programs, including time-out issues, state variability, and important privacy issues. These problems need to be addressed because these tools are used more frequently and more often.

Prescription monitoring program in medical practice

I work in emergency medicine, and the emergency department (ED) is at the forefront of this epidemic in many ways. We not only treat people who overdose, but many patients who come through our door feel in pain and need our help. But there are some patients who come to the ER with the sole purpose of getting a prescription for opioid pain medication, either for illegal use or for the purpose of selling it. This same individual can go to some ED, get some recipes in one day. ED is not the only place where this sort of thing happens; some patients are prescribed the same opioid drug by two or sometimes even three different doctors. Prescription monitoring programs: Helpful or harmful?

PMPs should help "get rid" of patients with this risky behavior, and allow prescriber to identify such individuals and ideally make them helpful. In spite of the good intentions, there are some unintended and negative consequences of the PMP. PMP can misbehave some patients. And for those people, the system could actually be more dangerous than good, including taking the many medications needed. The results included uncontrolled pain, inadequate palliative therapy, and in some cases encouraged patients to [1945900] to switch to illegally obtained recipes or street drugs such as heroin and fentanyl. Prescription monitoring programs: Helpful or harmful?

Unplanned anxiety from prescription monitoring programs

likes to use cases as examples. I have a young woman who came to my ED one day with the thought of hurting myself. He said that he felt hopeless and lost. He has been suffering from a chronic and painful condition for many years. A small dose of oxycodone daily regulates the pain and allows it to live a normal life. Other treatments did not work for her and she never misused this drug. When he replaced the primary care physician, his new doctor, who had accessed the PMP, stopped the prescription. While the concern was legitimate, which caused the patient pain and eventually took her to buy oxycodone from a friend, then on the road, and finally she started using heroin. He is now homeless, addicted, and contemplating suicide. This example is extreme, but illustrative. As we navigate the opioid epidemic, we must pay attention to proper use and abuse. Opioids have a place, such as when caring for people with cancer pain or those who receive palliative care or end of life. The deep concern among prescribers about abuse and diversion is completely justified, but we must ensure that the pendulum does not swing too far and cause harm to patients in need of these medications.

Prescription monitoring programs: Helpful or harmful?

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