Nowadays, it is not easy to be a prescriber that writes a large amount of controlled substance prescriptions on a daily basis.
The physician must be up to date on the proper use of pain medications and treatments.
Physicians have an ethical obligation to manage and relieve pain. Yet they must do so responsibly and in accordance with the law and medical compliance.
Controlled substances exist to alleviate any number of disorders and ailments, not must pain. They can be used for sleep disorders, weight loss, and other conditions.
However, physicians are subject to substantial regulatory and administrative burdens, simply for prescribing these medications.
On one, a physician is subject to malpractice charges of negligence for failure to adequately medicate a patient .
On the other hand, physicians can be sued for overmedication that results in addiction or serious adverse effects.
It is a difficult balance. They can’t over-prescribe, but they can’t under-prescribe.
In the short term they need to relieve a patient’s pain, and help them become healthy again.
In the long term, there are concerns of addiction, overuse, misuse, and adverse effects. The longer a patient is on opioids, the more potential problems can occur. Not to mention a steady tolerance towards those medications, and the need for a greater dosage. And the fact that evidence for long-term efficacy is lacking.
The challenge for physicians and policymakers is maintaining access to appropriate treatment while preventing the abuse and mistreatment of these opioids.
One solution has been for states to require physicians to research before writing initial prescriptions for medications containing controlled substances. The main tool here has been the use of Prescription Drug Monitoring Programs, or PDMPs. These PDMPs are more-or-less operational in ever state.
However, as physicians well know, the efficacy of these programs has been marginal at best. They represent a major disruption in workflow for the physicians, most of the systems are poorly designed and inadequate. The majority of them are underfunded due to state budget cuts. They are not synced with the EMR systems in place. They have redundant reporting requirements.
The need for a private system.
Trying to organize 50 disparate state systems is a nightmare for coordinators.
What is needed is a national program that is private, not beholden to taxpayer dollars and government budgets.
The system would need to be connected to electronic medical records systems and automatically report to these databases.
The system should be better designed, simple to use, and elegant, so as not to place too much burden on a physician in their workflow.
A national system could be standardized so the data would be uniformly reported to a single secure database that would be accessible across state lines to pharmacies, prescribers, and researchers on a confidential basis with appropriate privacy protections.
A national system would detect doctor shoppers that try to cross state lines to avoid detection.
It would limit the amount of reporting necessary, while still remaining compliant with current HIPPA and PPI mandates.
Hospital systems are still struggling to modify their operations to comply with Meaningful Use. It can be difficult, especially with respect to e-prescribing and prescription monitoring.
But there is a method of responsibly and securely prescribing controlled substances that serves the doctor, pharmacist, insurer, and patient. Something that protects prescribers, pharmacists and insurers from being manipulated into abetting prescription drug abuse.
Help is on the way.