Opioid analgesics, benzodiazepines, other sedatives and tranquilizers, and stimulants have important medical uses, stimulating the brain’s reward center(Becker

 Samantha Chanel De Vera

Posted Date

Jun 9, 2022, 12:11 AM

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Opioid analgesics, benzodiazepines, other sedatives and tranquilizers, and stimulants have important medical uses, stimulating the brain's reward center(Becker & Starrels, 2021). This can lead to misuse, substance use disorders or addiction, and other serious consequences in susceptible individuals. Principal strategies for clinicians to prevent prescription drug misuse and its consequences are optimization of alternative treatments, patient risk assessment, use of a treatment agreement, and limiting dose and early refills(Becker & Starrels, 2021). Patient risk assessment should include a history, physical examination, and consideration of the presence of contraindications to prescribing controlled substances such as current untreated substance use disorder, poorly controlled psychiatric illness, or erratic follow-up. Monitoring patients who prescribed a controlled substance should include regular follow-up, drug testing, and use of prescription monitoring programs or other information sources about patients who receive these medications from multiple prescribers. Monitoring should consist of documentation of benefits and harms of treatment, including assessment of functional status to assure that function is stable or improving on the current regimen, and evaluation for concerning behaviors that may indicate misuse or a substance use disorder(Becker & Starrels, 2021). 

State Prescription Drug Monitoring Program (PDMP) was designed to curb opioid misuse and diversion by tracking scheduled medications prescribed by medical providers and pharmacies(Dickson-Gomez et al., 2021). PDMPs were predicated on reducing excessive prescribing among medical providers or overlapping opioid prescriptions from multiple providers would reduce the supply of prescription opioids available for diversion and nonmedical use of prescription opioids. PDMPs have been shown to change physician prescribing behavior after implementation regarding the number of days opioids are prescribed, and morphine milligram equivalents (MMEs) prescribed. Overall, opioid prescribing rates have been shown to decrease in some states after implementing PDMPs(Dickson-Gomez et al., 2021).

References

Becker, W. C., & Starrels, J. L. (2021, April 6). Prescription drug misuse: Epidemiology, prevention, identification, and management. UpToDate. https://www.uptodate.com/contents/prescription-drug-misuse-epidemiology-prevention-identification-and-management?search=addiction&source=search_result&selectedTitle=4~150&usage_type=default&display_rank=4#H29430024

Dickson-Gomez, J., Christenson, E., Weeks, M., Galletly, C., Wogen, J., Spector, A., McDonald, M., & Ohlrich, J. (2021). Effects of implementation and enforcement differences in prescription drug monitoring programs in 3 states: Connecticut, kentucky, and wisconsin. Sage Journals, 15. https://doi.org/10.1177/1178221821992349