Tag: prescribing habits

Nurse Prescribed Patient 51 Pills Per Day, Kept License

The nurse practitioner was the ninth most heavy-handed opioid prescriber in Tennessee.

Forty opioid pills, four muscle relaxers, six Xanax and an Ambien in a day would likely do more harm than good for even the sickest of patients, but that’s the amount that a Tennessee nurse prescribed a patient eight years ago, exceeding today’s opioid recommendations by more than 31 times.

And yet, the nurse is still licensed to prescribe today.

Christina Collins, a nurse practitioner near Knoxville, was the ninth most heavy-handed opioid prescriber in Tennessee, and officials now say that she must have known that her patients were not taking the pills as she prescribed them.

“In short, Mrs. Collins was a machine that dispensed prescriptions without regard for any professional responsibility,” Mary Katherine Bratton, a Tennessee Health Department attorney, wrote in state documents analyzed by The Tennessean. “Her own lawyers argued that Mrs. Collins engaged in patient-led prescribing, simply giving patients whatever dangerous drugs they requested.”

Last year, officials attempted to have Collins’ license revoked, but the state nursing board opted to instead put her on professional probation, which means she can still write prescriptions. She still works as a nurse in the Knoxville area.

However, the state’s health department and attorney general are now appealing that decision in a move that a spokesperson called “rare but not unprecedented.”

Collins and her lawyer claim that despite doing things like telling one patient to wear three fentanyl patches at once in addition to taking other medications, Collins thought she was giving good medical advice at the time the prescriptions were written.

“She became a victim of her environment and the medical community and the ideas that were floating around out there at that time period,” said Eric Vinsant, her lawyer. “This case stretches from 2011 and 2012, which was a time before Tennessee really began looking at the prescribing of opioids and other controlled substances for pain, and there was really a very limited amount of guidance for practitioners on what was expected and what were best practices.”

Vinsant added that there was “no real evidence” that Collins’ pills were resold on the black market.

During a hearing with the nursing board last year, Collins said that she left the clinic she was with at the time when she became suspicious that Dr. Frank McNiel, who ran the clinic, was overprescribing. McNiel surrendered his medical license.

“When I initially started there … obviously I did not think that there was anything below the standard of care or anything wrong with the patients or the prescriptions they were taking,” Collins said, according to a transcript of the hearing. “If I were looking at doses like that in today’s time after the guidelines and everything that I’ve learned, yeah, I would think that was very high amounts.”

View the original article at thefix.com

16 October 2018
New Opioid Laws Seek To Curb Overprescribing

Though there is no hard evidence of the effectiveness of the laws yet, some professionals see the numbers as heading in the right direction.

As the opioid epidemic has continued to claim lives, more than two dozen states have put laws in place in the hope of limiting the damage.

Of those two dozen, the most recent states to take action are Florida, Michigan and Tennessee, according to Harvard Health Publishing. The new rules put in place set limits for the amount of opioids medical professionals can prescribe for pain relief from surgery, injury or illness.

Opioid laws vary from state to state, according to Harvard Health. While most states limit first-time opioid prescriptions to seven days, some states, such as Florida, Kentucky and Minnesota, have shortened it to three days unless a medical professional can give reason for a week-long supply.

“For almost all acute pain problems, including after surgery, a week is usually sufficient,” Dr. Edgar Ross, senior clinician at the Pain Management Center at Harvard-affiliated Brigham and Women’s Hospital, told Harvard Health.

Additionally, some states have put procedures in place that require doctors to take more steps when prescribing. In Florida, both physicians and pharmacists are required to take courses about prescribing practices. They must also search a drug database to make sure doctors aren’t doubling up on prescriptions for patients.

Massachusetts has a similar procedure in place, but some medical professionals say it’s not as simple as it sounds.

“We have the ability to check the registry to see who else has prescribed it, but it’s not integrated with electronic records,” Dr. Dennis Orgill, a surgeon at Harvard-affiliated Brigham and Women’s Hospital, told Harvard Health. “If you have someone who needs opioids over the weekend, you can imagine the logistics of that.”

Another new law, this one in Ohio, allows doctors to override and refill acute pain prescriptions, but only after a patient has gone through the first prescription.

According to Harvard Health, patients will typically have to return to the doctor to get a prescription rather than getting a refill on the phone. If for some reason a refill is made over the phone, Harvard Health states patients will end up visiting the pharmacy more often and making more copays as a result.

If doctors do not follow the new laws, they may face consequences. As a result, Harvard Health states some patients that need prescriptions for chronic pain are not getting them.

“Many doctors now refuse to prescribe any opioids because of the fear of sanctions,” Ross told Harvard Health. “I have had several cancer patients whose pain was not well managed because of incorrect perceptions.”

Although there is no hard evidence of the effectiveness of the laws yet, some professionals see the numbers as heading in the right direction.

“Massachusetts’ opioid legislation was signed into law in March of 2016. The overdose death rate then decreased by 8.3% in 2017, the first decrease since the beginning of the opioid epidemic,” Dr. Karsten Kueppenbender, an addiction psychiatrist at Harvard-affiliated Massachusetts General Hospital, told Harvard Health. “While it’s impossible to say the law caused the decrease, it’s certainly a welcome association.”

View the original article at thefix.com

27 September 2018
Are Opioid Prescription Regulations Actually Working?

New studies explored whether medical professionals are adhering to stricter opioid prescribing rules and regulations.

While rules and regulations are often made in the interest of public safety, that doesn’t mean they are always followed hard and fast.

Such is the case with certain rules regarding opioid prescriptions, according to the Boston Globe. The paper states that according to the results of two studies published Wednesday (August 22) in the journal JAMA Surgery, “such well-intentioned efforts sometimes don’t have the desired effect.”

The first study concluded that after one rule made it more difficult to refill the painkiller hydrocodone, surgeons began prescribing more of the medication right after surgery instead.

Meanwhile, the second study examined a regulation which required surgeons to check a database before prescribing opioids, the idea being that the database would alert them to patients at risk of opioid misuse.

However, the study found that the procedure took up surgeons’ time but did not affect their prescribing practices in one New Hampshire hospital.

According to the Globe, both the studies were limited in terms of geographic area and only studying surgeon’s prescribing behaviors.

Dr. Michael Barnett, a Harvard health-services researcher who studies opioid prescribing, tells the Globe that the results point to a bigger problem.

“Clinician behavior is harder to predict, when you put these kinds of limits on it, than we’d like to think,” he said. “Regardless of the law you put in place, physicians are going to respond to what patients need… We need to ask a harder question: How do we influence health care decisions?”

Prescribing practices have been under scrutiny for a number of years. In 2014, the Globe states, the U.S. Drug Enforcement Administration (DEA) changed hydrocodone from a Schedule III to a Schedule II drug, meaning patients would not be able to refill it over the phone.

After that went into effect, researchers at the University of Michigan chose to study the effects on post-surgery prescribing. They looked at prescriptions for 21,955 patients who had had elective surgery in 75 Michigan hospitals from 2012 to 2015. Study authors found that prescription refills decreased, but the number of pills a patient left the hospital with increased.

According to study author Dr. Michael Englesbe, the idea seemed to be that if doctors gave patients more prescriptions, they would be more likely to have the necessary pain relief and not seek more medication.

However, Englesbe says, previous research indicates that “the number of pills you give someone has no relationship to their likelihood of calling for a refill. The more pills you give a patient, the more they take, and they don’t rate their pain care any better. It’s counterintuitive.”

View the original article at thefix.com

24 August 2018
Do Free Meals From Pharma Reps Affect Doctors' Prescribing Habits?

A new paper examined prescribing numbers and marketing efforts by two pharmaceutical companies to determine if free meals made an impact.

Cardiologists who were taken out for a meal by sales representatives from two major drug manufacturers were 73% more likely to prescribe medication from those companies, even if equivalent, lower-costing generic drugs were available.

Those are the findings suggested by a new paper from the National Bureau of Economic Research (NBER), which also alleged that while an increase in prescribing certain drugs can be a positive for patients that use them, it can also take a toll on consumers by pushing more expensive drugs over cheaper alternatives; the paper’s authors estimated that the total cost was $190 million.

The paper also suggested that such marketing techniques for doctors should be eliminated altogether, as several states and health care systems have already done.

The paper looked at prescribing numbers and marketing efforts by two pharmaceutical companies, Pfizer and AstraZeneca—which make the cholesterol-lowering drugs Lipitor and Crestor, respectively—between the years 2011 and 2012. Meal payments were made the focus because they were the most popular form of courting doctors, and made for the majority of non-research payments during that time period.

As MarketWatch reporter Emma Court noted, meal payments are, “by their very nature, designed to be ‘pure persuasion,’ as opposed to payments for consulting or speaking.”

Meal payments were valued at less than $150.

As for the nature of the discussion, the paper’s authors opined that it was “very likely that statins”—drugs used to reduce fat levels in blood—”were the focus of any drug-related discussions,” since Lipitor and Crestor comprised the majority of both companies’ sales to cardiologists.

The researchers found that when the two companies’ sales representatives paid for meals when meeting with cardiologists, those doctors were 73% more likely to prescribe Lipitor or Crestor to their patients. It did not appear to matter what sort of meal it was; as the report’s authors noted, “it appears that the effect is driven by the receipt of any meal, regardless of its value.”

The information disseminated by the companies’ sales representatives also did not impact the doctors’ decisions; as Court wrote, both drugs had been available for nearly a decade (15 years, in the case of Lipitor), which meant that new information about either medication was unlikely to be provided at these lunch meetings, and lower-priced generic equivalents for both drugs were widely available.

Plying medical professionals with gifts, which ranged from simple meals to lucrative speaking engagements and consulting work, has been a regular sales and marketing practice for pharmaceutical companies.

But with studies like the NBER report suggesting that prescription rates rise and clinical treatment can be influenced after such treatment—which in turn can have a negative impact on health care costs and patient health—health industry observers and policymakers have turned to legislation that requires pharmaceutical companies to report all payments made to doctors, or ban such gestures altogether.

View the original article at thefix.com

4 August 2018
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

27 July 2018