Information for Prescribers
Maine has a significant and growing problem of nonmedical use and abuse of prescription drugs. The goal of the Prescription Monitoring Program is for prescribers to use this program as a tool to provide better care to your patients and to reduce the risk of addiction, diversion and overdose. The Office started and maintains this program emphasizing prevention, intervention, and treatment.
Data is submitted by pharmacies at least weekly, minimally cleaned, and stored in a centralized, relational database for all Schedule II, III, and IV drugs dispensed in Maine. The data is available to prescribers online. Reports are also automatically generated monthly for patients who cross certain thresholds. The monthly Patient Threshold Reports are mailed to the prescribers to whom the prescriptions were attributed.
Prescribers are encouraged to register as data requesters at: http://www.maine.gov/pmp
Anyone with a DEA number can register to request data on patients 24/7.
Using Patient Threshold Reports
If you receive a Patient Threshold Report, review your records to confirm that this person is a patient of yours and that you wrote the prescription(s) attributed to you. If you find that any of the records are inaccurate, please contact the pharmacy immediately. If you did write the prescriptions, patient safety generally dictates the need to discuss the patient with the other doctors listed on the report. During this discussion, you should decide collectively who will continue to provide prescriptions for the drugs to the patient (if indicated) and who might address any concerns about drug abuse with them. You may also want to keep the report in the patient's chart. The goal is to get people the treatment they need if they have a substance abuse problem. Click here for a list of treatment facilities in Maine.
We want to maintain a good working relationship among the state, prescribers, and dispensers as we use this system to provide better care to the people of this state and address the problem of prescription drug misuse. Please feel free to contact us with your questions and concerns: (207) 287-2595.
Suggested Framework for Opioid Prescribing
Based on recommendations outlined by A. Thomas McLellan and Barbara Turner in their editorial in the December 10, 2008 issue of JAMA entitled "Prescription Opioids, Overdose Deaths, and Physician Responsibility" (pp. 2672-2673), OSA has four guidelines for prescribing opioid medications:
- Use the PMP database before and during an on-going treatment regimen. Pulling a PMP “Patient History” report before and while prescribing to a patient can alert you to any past “doctor-shopping” or questionable behavior.
- Screen for substance abuse disorders or risk-factors before prescribing. If you find the patient has a substance abuse issue or is at greater risk, you should adjust your treatment plan accordingly.
- Prepare and have the patient sign a written treatment agreement (see our sample (Word) | (PDF); modify as desired).
- Follow-up with the patient every two or three months. This periodic follow-up should include a face-to-face office visit.
These recommendations were the editors’ response to an article by Hall et al (in the same issue of JAMA) in which a majority of overdose deaths in West Virginia involved prescription drug abuse. Research conducted by Marcella Sorg at the University of Maine has shown that the same has been true over the past decade in Maine.
How to Handle Prescription Drug Misuse
What if you find out a patient of yours has been using prescription drugs in a dangerous way? Information may have just come to you on a Patient Threshold Report, or you may see questionable behavior on a patient's online Patient History Report. The information given to you is a tool to help you better care for your patients and to get them the help they need if they are abusing prescription drugs.
Please remember that the patient's problem may be addiction. Addiction is a disease, and treatment is the best solution for it.
Things to consider as you talk to your patient:
- Do they have depression or anxiety?
- Do they need pain consultation with a specialist?
- Do they need psychiatric help?
- What treatment options are available?
- Is the problem addiction?
Discussing addiction and abuse with patients can be difficult, but it can lead them to a safer and better way of life. Find Help
Patients who are confronted about drug addiction may:
- Deny the accuracy of the information on the report
- Plead or try to bargain with you
- Threaten harm to self or others
- Admit their problem but have no intention of following through on any recommendations
- Try to justify their actions
- Shift responsibility for their behavior to others.
These reactions are characteristic of addictive behavior.
Care and Understanding
Patients with drug abuse problems are likely to be frightened and desperate. They may have a distorted concept of their behavior, believe nothing is wrong, or convince themselves that someone else is to blame. As you attempt to defuse arguments and calmly present the facts, you can offer helpful suggestions that may guide your patients into treatment.
Drug abuse is a complex problem. You may want refer to specialty care or consult with an addiction specialist, psychiatrist, or pain specialist.
Overdose deaths and addiction related to prescription drugs are troubling and very real issues. SAMHS encourages you to use the PMP to your advantage to provide safer and better care to your patients.
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