Clinic Policy Could Help Curb Prescription Drug Abuse
> 4/14/2008 2:06:06 PM

Prescription drug abuse has become an increasingly recognized problem, and many people, especially teens and young adults, continue using powerful medications, including painkillers like OxyContin and Vicodin, to get high. But unlike other drugs, which are sold on the street, these drugs are usually obtained from a doctor's office, and doctors can take steps to counter the current rates of abuse. Last week at the annual meeting of the Society for General Internal Medicine, researchers from the University of Michigan and Ohio State University presented a new strategy that may help physicians to more effectively monitor their patients and prevent prescription drug abuse.

The researchers developed a standardized policy that would apply to individuals prescribed painkillers for pain not related to cancer treatment. They then tested their policy in a busy clinic where patients often received treatment from more than one physician, a setting that can make prescription drug abuse more difficult to detect. The policy consisted of several components designed to help physicians screen their patients for signs of substance abuse. First, the clinic created a registry of all patients prescribed a painkiller for non-cancer pain. Each patient was listed with the name of their prescribing physician, which established a link between the patient and the physician who would monitor their treatment plan. In addition to the registry, the clinic required each patient and their physician to sign an agreement explaining the monitoring process and the actions prohibited to patients. Those who broke the agreement would no longer be allowed a prescription for painkillers. The patients also agreed to undergo random urine testing, a method that allowed physicians to identify patients who had used illict substances or other medications that could result in a dangerous interaction. To further aid the physicians, the researchers taught them to use a state database of prescription records that they could use to see if a patient has sought prescriptions from multiple doctors.

With these policies in place, the physicians were able to identify patients who had abused their medications or other drugs and take appropriate actions. Out of the 167 patients who had received a painkiller prescription, 35 percent did not adhere to the agreement they had signed. Those who had been prescribed OxyContin or another medication using its active ingredient, oxycodone, were twice as likely to be in violation of the clinic's policy. These individuals were allowed to continue receiving medical care from the clinic, although they were no longer allowed prescription painkillers, and they were referred to a treatment program that would help them overcome their addictions.

Prescription drug abuse remains a significant and complicated problem for physicians and their patients. Prescription painkillers, when used appropriately, can improve the functioning of many individuals in pain, but it is important to remember that these medications can be highly addictive and have dangerous consequences. While some individuals obtain a prescription intending to sell the drugs or use them recreationally, many others take these drugs for a legitimate reason and become addicted accidentally. By discussing with their patients the serious risks of abusing prescription medications, keeping lines of communication open, and implementing policies such as the ones examined in this study, physicians can help their patients avoid addiction and identify those who have abused their medications and are in need of help. The researchers plan to continue studying these policies, and their work may yield an even better understanding of the most effective ways to prevent prescription drug abuse.

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