Safe and Effective Prescribing of Controlled Substances (FL INITIAL Autonomous Practice - Differential Diagnosis)

Course overview

Prescription opioid abuse takes a heavy toll on the patient, healthcare provider and society. Abuse and misuse of controlled substances occur for multiple reasons, including self-medication, use for reward, diversion, and for-profit and compulsive use. Opioid use has recently increased, leading to increased abuse and opioid overdoses. Proper screening lowers the risk of iatrogenic addiction. Unfortunately, no currently available screening method accurately predicts who is at high risk of abuse or misuse opiates (Sehgal et al., 2012). Using prescribed medications not as directed describes potentially aberrant drug-taking behaviors. In a study of 202 patients, only 44.1% were screened for potential aberrant drug-taking behaviors. It was concluded that screening for abuse or misuse of opioids does not frequently occur in large family medicine training programs. More training and set policies for risk evaluation and monitoring of opioid abuse are needed (Colburn et al., 2012). Health care providers tend to under-assess patients at risk for opioid-related aberrant behaviors. One study showed that providers assessed the risk of misuse, abuse or diversion at less than 2% when in reality, 10.4% of patients had prior illicit drug use, 23.4% had abnormal urine drug tests, and almost 11% reported crushing or chewing opioids in the past and 60% of patients self-reported abuse, misuse or diversion (Setnik et al., 2017). Prescribers' lack of training and inexperience can profoundly impact the misuse of medications. One study showed that resident physicians (when compared to attending physicians) more often prescribed opioids for more than three months, were more likely to have their patients report that their prescriptions were lost/stolen, and were more likely to have patients who exhibited substance misuse and were more likely to have their patients get opioids prescribed by a different prescriber in addition to them (Colburn et al., 2012). Prescribers receive little training in prescribing scheduled substances, screening for substance abuse, and referring patients who need treatment. Proper continuing education is one way to address this problem (Brown et al., 2012).