02 May Standardized Monitoring Needed for Prescription Painkillers
The use of prescription drugs for non-medical purposes has become a serious public health issue, with prescription drug abuse ranking second among illicitly used drugs. In many cases, the abuse stems from a chronic pain complaint, in which a patient is prescribed an opioid, but without adequate warning about its addictive effects.
Researchers at the Albert Einstein College of Medicine at Yeshiva University say that few doctors give adequate attention to prescribing opioids to patients, despite the high risk of abuse, addiction and overdose.
In a study published online March 2 in the Journal of General Internal Medicine, the researchers found that there was not appropriate monitoring for opioid prescriptions, even when the patient was at a high risk of opioid misuse with a history of drug abuse or dependence.
Lead author Joanna Starrels, M.D., M.S., Assistant Professor of Medicine at Einstein, explains that the findings of the study provide support for a standardized approach to monitoring.
The research team evaluated the administrative and medical records for over 1,600 patients who were receiving prescription opioids for chronic, non-cancer pain. The records were analyzed for whether urine drug testing occurred, whether the patients were seen regularly in the office and whether the patients received multiple early refills for opioids.
Very few of the patients (about 8 percent) were asked to provide a urine test. While testing was highest among those who were considered high-risk for abuse, the testing among those patients was only 24 percent. About half of patients given opioid prescriptions were seen regularly in the office and the frequency was not increased for those at a higher risk of opioid abuse.
While less than a quarter (23 percent) of patients received two or more early opioid prescription refills, patients considered at a greater risk for misuse were more likely to receive multiple early refills.
The National Institute of Drug Abuse reported in 2004 that 48 million people over the age of 12 have taken prescription drugs for nonmedical uses in their lifetime. This equates to about 20 percent of the total population. Among the drugs most commonly misused were opioids.
While many doctors are aware of the risk of prescription opioid abuse, many do not have a set of standardized procedures to prevent the misuse of prescription opioids by their patients. The findings of this study highlight the need for a process that will prevent multiple early refills and require periodic office visits by patients prescribed with opioids.
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