Nurse Practitioner Calls Primary Care Physician (PCP)
Prescription Monitoring Programs (PMPs)
- All prescription writing healthcare providers should have access to their state’s Prescription Monitoring Program
- Check a patient’s prescription record on the state PMP prior to prescribing any opioid medication, including buprenorphine
- Depending on the state, you may need to perform an advanced search to check prescriptions provided to your patients in another state
- Identify patients at risk for polypharmacy
- Identify patients who have developed opioid use disorder
- PMPs are a useful tool to track a patient’s success or continued struggle with medication assisted therapy
Abuse, Addiction and Diversion Mitigation Strategies
- Prescription Monitoring Programs (PMPs)
- Prescription monitoring programs may not cross state lines, which makes these systems vulnerable
- I-STOP is the New York State PMP (see next slide); provider needs to indicate an ‘expanded search’ to access data from PMP with currently 30 other participating states
- Opioid contracts/agreements
- Close tracking of prescriptions and refill intervals
- Regular patient follow up to reassess drug efficacy, tolerability and safety of the therapy over time
- Periodic urine toxicology
- Be aware that many state PMP programs do not include information from the VA system, so your VA patients may be receiving Schedule II medications that you are unaware of
Examples of Substance Use Risk Assessment Tools
ORT: Opioid Risk Tool
PPM: Practical Pain Management
DIRE: Diagnosis, Intractability, Psychological Risk, Chemical
Joyce’s Second Meeting with Primary Care Practitioner (PCP)
Diagnosis of Substance Use Disorder
Present with two or more of the following:
- Using increased quantities of substance over time
- Inability to control/regulate use of a substance
- Considerable time spent in use and procurement
- Strong desire to use the substance (cravings)
- Substance interferes with major life roles
- Ongoing use despite harmful effects on relationships
- Ongoing use despite harmful physical or psychiatric effects
- Substance causes avoidance of social, work or leisure activities
- Ongoing substance use despite it posing risk of physical harm
- Presence of tolerance to the substance
- Presence of substance dependence
