Diversion and misuse of prescription drugs is a growing problem, but one that physicians can help prevent by asking patients about their addiction history before prescribing drugs with high abuse potential, experts say.
AMANews reported March 17 that doctors who want to prescribe adequate medication to treat pain can take a number of precautions to avoid running afoul of law enforcement or unwittingly contributing to an addiction problem. “Because so many patient problems have fallen at the feet of primary care, we need to look at ways primary care can be part of the solution and not part of the problem,” said Michael M. Miller, M.D., president of the American Society of Addiction Medicine.
Miller advises doctors to start by asking about the patient’s past history with alcohol and other drug addiction as well as past problems controlling prescription medication use. Prescribing only as much medication as the patient will reasonably need also can prevent diversion or misuse, such as kids or others taking unused pills from a parent’s medicine cabinet.
“We hate to see somebody in pain run out of medicine, so sometimes we may be a little too generous,” said Kyle Kampman, M.D., medical director of the Charles O’Brien Center for Addiction Treatment at the University of Pennsylvania. “Patients tell me they worked as a maid at the height of their addiction and they would go through people’s medicine cabinets. I had a patient who was a roofer tell me, ‘If you ever let a roofer in your house and in the bathroom, chances are they are looking through your medicine cabinet.’”
Patients returning early to seek a refill of their prescription also should raise a red flag with physicians. “It’s a joke among addiction providers that sinks and toilets seem to be magnets for people’s medications,” said Kampman. “That’s an excuse you often hear: ‘I dumped my medicine down the sink or down the toilet.’ So that should ring alarm bells.”
If a problem is suspected, doctors should question patients directly, said Kampman. Some will admit an addiction problem and can be referred to treatment, while others may need stronger medications for their pain and should be referred to a pain specialist.
Doctors also should be careful to adhere to rules requiring them to conduct a physician exam before prescribing medication, and inform patients that sharing prescription drugs with others is illegal and that leftover medicine should be destroyed.
Finally, doctors can now check prescription-drug databases to find out if patients are “doctor shopping” — visiting multiple physicians for prescriptions to feed their addiction or illicit sales. “It takes about 30 seconds to check to see if patients are filling other prescriptions,” said family physician Terry Haffner, M.D., of Kokomo, Ind., where such a tracking system is now in place.
From Join Together Online