Drug-use data aid emergency doctors with opioid prescribing

Prescription drug monitoring programs can help emergency physicians better determine which of the patients presenting with pain complaints are legitimately in need of treatment and which are seeking to abuse narcotic painkillers, according to a study published online July 11 in the Annals of Emergency Medicine.

Researchers examined the treatment of nearly 600 patients with one of three chief complaints that could result in painkiller prescriptions and lack objective physical findings — back pain, dental pain and headache. The patients were treated by 35 emergency physicians and three nurse practitioners at two medical centers in the same city. About 10% of the time, using the drug-monitoring database resulted in a change in prescribing, said the study (link).

Seven percent of the time, patients whom the prescribers suspected of engaging in drug-seeking behavior were prescribed painkillers after the database was consulted. That is because the patients' records did not meet objective criteria of abusive behavior, defined as getting four or more opioid prescriptions from four or more doctors in the previous 12 months. Meanwhile, 3% of the time, health professionals decided against prescribing opioids after finding evidence of drug-seeking behavior in the database.

Patients who requested drugs by name, made multiple ED visits for the same complaint or had pain symptoms that were disproportionate to what was found on examination had higher odds of drug-seeking behavior, the study said. Drug-monitoring data are especially helpful for emergency physicians who must make tough calls on narcotic prescribing without the benefit of a preexisting relationship with patients, said Scott G. Weiner, MD, MPH, the study's lead author. He also is an emergency physician at Tufts Medical Center in Boston.

“This information can help us strike that balance between treating legitimate pain and restricting opiate access to those with abuse potential,” Dr. Weiner said. “Our study suggests that the use of certain criteria combined with prescription-monitoring programs may help us find that sweet spot in the middle.”