MDNews - Minnesota

++++++++++++++ + +ETHICS +++ ++++++++++++++ +++ Is Your Patient Abusing or Misusing? WITH THE NUMBER OF METHADONE-RELATED DEATHS INCREASING BY 272% FROM 2001 TO 2006, THE QUESTION OF WHO IS RESPONSIBLE FOR PREVENTING PATIENT PRESCRIPTION ABUSE IS MORE IMPORTANT THAN EVER. P REVENTION SHOULD BE an effort made across the health care spectrum, but it's important to know what you can do as a physician to ensure your patients don't become a statistic. While methadone has been used for more than 40 years to treat opioid addiction, it has only been used to treat chronic pain for the past 10 years. In fact, between 1998 and 2006, the number of methadone prescriptions increased almost 700%. According to the Substance Abuse and Mental Health Services Administration, only 5- and 10-mg strength tables have been approved by the FDA for pain management, but other formula- tions have been prescribed. Increased Availability Leading to Increased Abuse The increase in frequency of methadone being prescribed has led to an increase in opioid-related overdoes and deaths, due to diversions of methdone. These diversions are either done willingly by patients who sell or give their medication to others or unwillingly when patients lose or have their medications stolen. People are becoming more experimental and taking metha- done for the "high." According to the 2008 National Survey on Drug Use and Health, the nonmedical use of prescription pain relievers by fi rst-time users was equal to the amount of fi rst-time marijuana users. However, the risks are either known or of no concern to those trying to get "high." Emergency room visits for nonmedical use increased 23% from 2004 to 2006. Eighty four percent of methadone-related deaths in 2006 were accidental. Some deaths occur in those who are legally prescribed methadone, but many were misusing it as opposed to abusing it. These are patients who weren't educated on how to safely take the prescription and the importance of not self-medicating, using more than the dosage prescribed or the risks of combining the medication with other drugs or alcohol. Two-thirds of methadone deaths involved the patients using other drugs, particularly antidepressants, alcohol and cocaine. Patients' Safety Responsibility Increasing patient safety and decreasing methadone diversion, misuse and abuse is a responsibility that falls on all health care providers, from prescribers to pharmacists, and the patients themselves. Prescribers can take the following measures to improve patient safety: + Educate patients about how to safely take their prescription including the importance of only taking the prescribed dosage and the dangers of mixing their prescription with other medications or alcohol. + Inform patients of disposal methods. + Give patients information about the signs of methadone overdose. + Assess the risk of misuse by researching personal or family history of abuse. + Create a substance agreement that creates a monitoring plan and explains the actions taken if abuse is suspected. + Require urine drug tests and pill counts within 24 hours of an early refi ll request. + Keep prescription blanks in a place where they can't be stolen and never sign prescription blanks in advance. + Assist the pharmacist if he or she calls to verify information about an order. It's important to remember that while a physician's role is to care for patients, it's just as important to avoid contributing to diversion and to protect the health of the general public. n

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