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Tag: overprescribing

  • "Death Certificate Project" Helps Identify Doctors Who Overprescribe

    "Death Certificate Project" Helps Identify Doctors Who Overprescribe

    The crackdown has spooked physicians, including some who say they’re now less inclined to treat complex patients. 

    Hundreds of California physicians are under investigation for their prescribing habits, as the state medical board cracks down on overprescribing.

    Under the “Death Certificate Project,” the Medical Board of California is trying to take a proactive approach to identifying overprescribing behavior.

    The board, a state agency that licenses/disciplines physicians, has reviewed death certificates that list a prescription opioid (or more) as the cause of death, then identify the provider(s) who prescribed the controlled substance to the patient “within three years of death, regardless of whether the particular drug caused the death or whether that doctor prescribed the lethal dose,” MedPage Today reports.

    Prescribers were matched to patients through California’s prescription drug database, CURES (California Controlled Substance Utilization Review and Evaluation System).

    “Our goal is consumer protection… (to) identify physicians who may be inappropriately prescribing to patients and to make sure that those individuals are educated (about opioid guidelines), and where there are violations of the Medical Practices Act, the board takes (disciplinary) action,” said Kimberly Kirchmeyer, the medical board’s executive director.

    So far, 462 physicians have been identified as “warranting an investigation of patients’ files,” according to MedPage. Of these cases, 223 have been closed for either insufficient evidence, no violation, their license was already revoked/surrendered, or the physician has died.

    Nine physicians have been targeted in opioid-related prescribing accusations filed by the state Attorney General; four of them were already under scrutiny on “unrelated charges.”

    The state’s crackdown has spooked physicians, including some who say they’re now less inclined to treat complex patients.

    “When you hear a bunch of doctors all at the same time all getting the same letter, and you realize they’re going through the same thing, you see why some are saying [to patients], ‘Sorry, if you have a lot of medical conditions, we’re not going to take care of you,’” said Dr. Brian J. Lenzkes, a San Diego internist and one of the targets of the Death Certificate Project.

    Last December, Lenzkes received a letter from the state medical board notifying him that there had been a “complaint filed against you” about a patient who had died of a prescription drug overdose in 2013.

    According to Lenzkes, the patient’s severe condition required him to take a regimen of prescription drugs including painkillers.

    After receiving the letter, however, Lenzkes says he’s more wary of taking on pain management, saying that he’ll refer patients to pain specialists instead. “I’m not taking any more. That’s just how I feel,” he said.

    View the original article at thefix.com

  • Opioid Prescribing Varies Widely By Region, Study Shows

    Opioid Prescribing Varies Widely By Region, Study Shows

    In some states, patients were up to three times more likely to be prescribed opioids.

    Whether or not patients are prescribed opioids in the emergency room and how many of the pills they get varies widely by region, according to a new study, suggesting that despite increased awareness about the dangers of opioids there is still plenty of room to cut down on unnecessary prescribing. 

    According to Science Daily, researchers from the University of Pennsylvania School of Medicine examined insurance claims to see how patients presenting with sprained ankles were treated for pain.

    In some states, patients were up to three times more likely to be prescribed opioids. Researchers also found that people who received more opioid pills were five times more likely to fill an additional opioid prescription over the following six months. 

    “Although opioids are not—and should not—be the first-line of treatment for an ankle sprain, our study shows that opioid prescribing for these minor injuries is still common and far too variable,” said M. Kit Delgado, MD, MS, an assistant professor of Emergency Medicine and Epidemiology at Penn who led the study. 

    “Given that we cannot explain this variation after adjusting for differences in patient characteristics, this study highlights opportunities to reduce the number of people exposed to prescription opioids for the first time and also to reduce the exposure to riskier high-intensity prescriptions,” Delgado said. 

    The study examined more than 30,000 patient records and found that 25% were given opioids. 

    “Although prescribing is decreasing overall, in 2015 nearly [25%] of patients who presented with an ankle sprain were still given an opioid, a modest decrease from 28% in 2011,” Delgado said. “By drilling down on specific common indications as we did with ankle sprains, we can better develop indicators to monitor efforts to reduce excessive prescribing for acute pain.”

    Researchers found that there was a huge variation between states in the percentage of patients given opioids. For example, only 3% of patients received an opioid prescription in North Dakota, compared to 40% in Arkansas. If states with above-average prescribing were reduced to the average amount, 18,000 fewer opioids pills would be prescribed each year. 

    In addition, if all patients were given the smallest supply of opioids, usually 10-12 pills, there would be a significant reduction in the number of pills distributed. 

    “Simply making these amounts the default setting electronic medical record orders could go a long way in reducing excessive prescribing as our previous work has shown,” Delgado said, noting that the concept could be expanded to other areas of care.

    “It would be great to see analyses such as ours replicated in other settings, such as post-operative prescribing, where prescriptions are higher intensity. In these settings there may be greater opportunities to decrease transitions to prolonged opioid use by reducing excessive prescribing.”

    View the original article at thefix.com

  • FDA: Limiting Opioids Won't Curb Crisis, Responsible Prescribing Will

    FDA: Limiting Opioids Won't Curb Crisis, Responsible Prescribing Will

    The FDA commissioner issued a statement addressing the stigma aimed at pain patients and the need for providers to take a patient-centric approach.

    Strict opioid prescribing regulations are harming some chronic pain patients, according to U.S. Food and Drug Administration Commissioner Scott Gottlieb.

    On Monday, July 9, the FDA released a statement about its Patient-Focused Drug Development Meeting, during which Gottlieb brought up the struggles some patients face because of strict opioid prescribing laws. 

    According to PatientEngagementHIT, there are some instances in which patients, such as those those facing “metastatic cancer pain management and chronic migraine management,” are best fit for a long-term opioid prescription.

    “Tragically, we know that for some patients, loss of quality of life due to crushing pain has resulted in increased thoughts of or actual suicide,” Gottlieb said in the statement. “This is unacceptable. Reflecting this, even as we seek to curb overprescribing of opioids, we also must make sure that patients with a true medical need for these drugs can access these therapies.”

    While Gottlieb acknowledges that prescribing regulations are necessary in order to fight the opioid crisis, he also says those strategies are negatively affecting patients who rely on the medications for pain management.

    Gottlieb and his colleagues have learned through patient workgroups that patients in need of pain management say they feel stigmatized and have a difficult time building healthy relationships with care providers.

    According to Gottlieb, simply banning opioids or increasing the difficulty of obtaining a prescription is not the solution to the issue. He says instead, better education needs to be available to providers and opioid prescribing should take a “patient-centric” approach, taking patient “preferences, needs, and patient education approaches” into account.

    “Balancing the need to maintain access with the mandate to aggressively confront the addiction crisis starts with good medical management,” Gottlieb said in the statement. “All patients in pain should benefit from the skillful and appropriate care of their pain. It’s also critical that we take this same aggressive approach to changing the culture of medicine around treating pain… Patients in pain deserve thoughtful, careful and tailored approaches to the treatment of their medical conditions.”

    The statement also outlines steps the FDA has taken to push responsible prescribing methods. For example, the FDA released a blueprint for drug manufacturers focusing on how they can educate prescribers. Additionally, the FDA is working with medical professionals to develop resources for clinicians.

    “We need to be mindful of this history, learn from it and make sure that we act aggressively to confront new trends that may continue to fuel the current crisis or lead to a new epidemic of addiction,” Gottlieb explained.

    The FDA also stated that combating the opioid crisis should not involve limiting or banning opioids, but instead has to do with better education about practices.

    “Our goal is to support more rational prescribing practices, as well as identify and encourage development of new treatment options that don’t have the addictive features of opioids,” Gottlieb said in the statement. “In this way, we’ll help ensure that we’re not unnecessarily putting patients as risk of addiction by overprescribing opioids, while also maintaining appropriate access to care for patients with serious pain. In pursuing these goals, we must make sure that patients inform our work.”

    View the original article at thefix.com

  • Overprescribing Doctor Linked To Hundreds Of Deaths, Report Says

    Overprescribing Doctor Linked To Hundreds Of Deaths, Report Says

    The doctor’s “brusque and indifferent” prescribing of diamorphine led to the deaths of at least 456 patients between 1989-2000.

    A British doctor is making headlines once again, after a report released Wednesday (June 20) concluded that her policy of over-prescribing a powerful pain medication led to hundreds of patient deaths.

    Jane Barton, who is now retired, was found guilty of serious professional misconduct in 2010 by the General Medical Council (GMC) for her “excessive, inappropriate and potentially hazardous” prescribing of medication at Gosport War Memorial Hospital on the south coast of England, but was allowed to continue practicing medicine with some limitations.

    Although Barton retired the same year, families of the victims, outraged by the decision, have since fought for Barton to be held accountable for her alleged actions.

    On Wednesday, the Gosport Independent Panel released findings of a four-year investigation. While the Guardian states that “there is no suggestion that Barton intentionally took lives,” her “brusque and indifferent” prescribing of diamorphine (synthetic heroin) led to the deaths of at least 456 patients between 1989-2000, and potentially shortening the lives of another 200 patients.

    The report determined that “there was a disregard for human life and a culture of shortening the lives of a large number of patients,” and that the opioid-prescribing policy under Barton’s direction was “without medical justification.”

    “It represents a major crisis when you begin to doubt that the treatment they are being given is in their best interests,” said Rev. James Jones, chair of the independent panel. “It further shatters your confidence when you summon up the courage to complain and then sense that you are being treated as some sort of ‘troublemaker.’”

    On the day of the report’s release, British Health Secretary Jeremy Hunt apologized for the deaths “on behalf of the government and the (National Health Service).”

    The panel’s report mentions Harold Shipman, Britain’s worst serial killer, “in order to understand the context of events” in Barton’s case.

    According to CNN, Shipman was found to have killed 215 of his patients over a 23-year period. According to a review led by High Court Judge Dame Janet Smith, Shipman also administered excessive doses of diamorphine to his patients from 1975 to 1998. He was ultimately sentenced to 15 terms of life imprisonment, according to the latest report. He ultimately died by suicide in his prison cell in 2004.

    Still, Janet Barton maintains that she never meant to kill, and that her harmful prescribing was the result of the “excessive and increasing burden” of trying to care for too many patients.

    “Throughout my career I have tried to do my very best for all my patients and have had only their interests and well-being at heart,” Barton said in 2010.

    View the original article at thefix.com