Prescription drug abuse creates liability, regulatory issues for practices

Prescription drug abuse is the nation’s fastest-growing drug problem, according to the Office of National Drug Control Policy, and unless primary care practices take appropriate precautions, it could become one of their fastest-growing regulatory and liability issues as well.

A recent report said that deaths from prescription drugs in the United States have quintupled since 1990, and that prescription drugs are involved in more overdose deaths than heroin and cocaine combined. Much of the concern in that report centers around illicit use of the drugs and illegal prescribing by so-called “pill mills” and shady Web sites. But several action items also directly affect legitimate medical practices.

“Prescription of opioids is an increasing challenge for clinicians, who have to weigh the substantial pain relief these medications can provide against the potential for dependence, abuse, and diversion,” according to the report, the 2011 Drug Control Strategy, which calls on physicians to play a larger role in detecting and preventing prescription drug abuse.

Look for the following initiatives to affect your practice:

• A push for greater use of screening, brief intervention, referral, and treatment (SBIRT) processes to help identify drug abusers. In 17 states, Medicaid reimbursement codes already pay for SBIRT.
• New government-sponsored educational programs on addiction developed for practicing physicians and medical students and evidence-based treatments for substance dependence.  
• The use of electronic health records (EHRs) to detect overprescribing or inappropriate drug combinations.
• Possible requirements that physicians instruct patients on proper disposal of opioids and other addictive medications, including using “take-back” programs where drugs are returned to a central location, such as a community pharmacy.

Compliance with such programs may be time-consuming for you and your staff, but they could also help protect you against mistakes that might lead to malpractice lawsuits.

A recent study in a special issue of the journal Pain Medicine looked atmalpractice lawsuits involving patients who overdosed while consuming therapeutic opioids. In 80% of cases involving a death, the patient had evidence of a current or past substance use disorder, and in 40% of those cases the patient had a mental health disorder.

One of the researchers reviewed 35 overdose cases, 20 of them fatal, which led to lawsuits from 2005-2009.

The study found that the most common physician errors were:

• Initiating a too-high starting dose or titrating doses too rapidly;
• Converting to a different opioid without following appropriate guidelines;
• Not screening or monitoring for medical or mental comorbidities that can compromise opioid therapy;
• Failing to keep up with new advances, e.g. changing labeling on methadone, which was responsible for half the deaths, and not recognizing danger signals, such as patients who seek refills too early, indicating that they are over-medicating themselves.

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