Vital Signs Blog

Docs still prescribing drugs after identifying alleged drug-seeking patients, ACEP study shows

Emergency department doctors are being blamed for prescribing painkillers like OxyContin to drug-seeking patients, and 48 states have created or passed laws to create prescription drug monitoring programs to help identify who they are.

But a new study by the American College of Emergency Physicians found that clinicians actually prescribed more painkillers for alleged drug-seeking patients—identified as those who seek painkillers from four or more different physicians or hospitals in a twelve-month period—after checking with the monitoring programs.

Ironically, that increased prescribing by clinicians came after they had assessed 35.6% of patients as drug seekers, while the state program assessed just 23.2% as drug seekers. In addition to getting prescriptions from four different physicians, these drug-seekers could be patients who asked for a specific drug by name or had a suspicious history with multiple ED visits for the same complaint.

There's been controversy on how clinicians diagnose legitimate pain, and groups like the Joint Commission have attempted to develop better guidelines. “Because pain is so subjective, we are guided by our experience and our gut when deciding what pain medications to use for patients,” said the study's lead author, Dr. Scott Weiner from Tufts Medical Center. “Data from the (prescription drug monitoring programs) provide important objective criteria to help better inform prescribing decisions.”

Researchers took data from 38 emergency providers over 544 patient visits from June 2011 through January 2013. Clinicians altered their prescription plans for 9.5% of their patients after consulting with the state drug monitoring program. Those changes included prescribing meds to 6.5% more patients than previously planned and not prescribing drugs to 3% patients who originally were going to receive medications.

Researchers acknowledged how drug monitoring programs have reduced shipments of painkillers in some states.

Follow Ashok Selvam on Twitter: @MH_aselvam


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