Physician Monitoring: Does It Curb Opioid Dependency & Abuse?
A new study published in the journal Health Affairs suggests that one of the best ways to curb opioid dependency and abuse is to monitor the prescribing habits of doctors.
In fact, states which began tracking doctors (via prescription monitoring program) and their corresponding prescriptions saw a 30% reduction in the rate of opioid prescriptions and other controlled substances.
From the study:
“This reduction was seen immediately following the launch of the program and was maintained in the second and third years afterward.”
However, the researchers aren’t entirely certain as to the reason monitoring cuts prescriptions:
“It is possible that the implementation of a prescription drug monitoring program by itself substantially raised awareness among prescribers about controlled substance misuse and abuse and made them more cautious when prescribing pain medications with a great potential for abuse and dependency.”
“It is also possible that knowing that their prescribing was being ‘watched’ deterred them from prescribing Schedule II opioids to some extent.”
According to the Drug Enforcement Agency, Schedule II drugs have a high potential for abuse, and may lead to significant psychological or physical dependence. Examples include: hydromorphone (Dilaudid), oxycodone (OxyContin, Percocet), and fentanyl (Sublimaze).
There is also a fine line (and perhaps some hypocrisy) between Schedule I and Schedule II drugs. Schedule I drugs have no known clinical value, and include both marijuana and heroin. Neither of these drugs are anywhere near as potent as fentanyl.
The Centers for Disease Control and Prevention agrees that doctors are definitely part of the problem – for two reasons. One, they may be over-prescribing painkillers – and two, they may be naive to patients who are doctor-shopping, or turn around and resell their pills to others.
The most famous victim of opioid abuse in recent times is the artist Prince. The coroner announced the results of his toxicology last week, and reported that he died from an overdose of the very powerful drug fentanyl. It was unknown many close to him that he had developed opioid dependency.
According to the CDC, Opioid drugs killed over 47,000 persons in 2014, about 15,000 more people than traffic accidents. Also, in 2013, the CDC reported that 1.9 million people abused or were dependent upon some opioid pain medication.
Earlier in 2016, researchers at Stanford University reported that the biggest prescribers of opioid drugs were primary care physicians – not pain specialists. Sales of prescription painkillers increased 300% since 1999.
Before states began prescription drug monitoring programs, around 5.5% of office visits for pain resulted in a prescription for a Schedule II narcotic painkiller. After a program implementation, that number dropped to only 3.7%, about a 30% reduction.
Researchers also noted that changes in prescribing habits (in a response to prescription drug monitoring programs) probably represent a move toward more appropriate prescribing.
However, they also stated that they could not be sure if doctors were actually making the right decision.
“We…could not evaluate whether patients’ pain management needs were adequately met and whether this changed as a result of drug monitoring program implementation.”
The new guidelines put forth by the CDC recommended that doctors try different forms of pain management rather than using opioids as a first line of defense. If they do deem them necessary, they should start with the lowest dose. Over time, this may reduce the risk of opioid dependency and abuse.
Thus, one of the problems is that there is no way to know if the changes represent more responsible prescribing, or if they are scaring doctors into under-treating pain again. Most likely, both scenarios are occurring.
~ G. Nathalee Serrels, M.A., Psychology