Curbing Prescription Drug Abuse

Prescription drug abuse specifically opioids is a pervasive multi-dimensional issue impacting individuals, families, and communities in Tennessee with disastrous and severe consequences for Tennesseans of every age. To deal with this serious issue, the Tennessee Department of Mental Health and Substance Abuse Services recently produced the report “Prescription for Success: Statewide Strategies to Prevent and Treat the Prescription Drug Abuse Epidemic in Tennessee”.

Data gathering and sharing is just one of the current efforts being made in the state to curb prescription drug excess. One specific effort concerns the ability to collect data and share the data within the state.

Efforts are also being made to increase understanding and the seriousness of the problem, to identify patterns of misuse and abuse of the drugs involved, and better target limited resources by focusing on what has proven to be effective.

The State formed the Substance Abuse Data Taskforce to provide an understanding of the extent of the problem, identify patterns of misuse, and address several issues including the use of similar formats and language.

Also the Controlled Substance Monitoring Database was initiated to collect data on controlled substances in the state and to identify unusual prescribing and/or dispensing practices. At the same time, the database is able to take into account particular specialties, circumstances, and patient-type or location of the prescriber or dispenser. The database provides information to prescribers and dispensers on the controlled substance prescriptions that their patients may be receiving from other prescribers.

A notification system is able to send clinicians alerts when their patients have met certain risk thresholds. These thresholds were developed by analyzing prescription data in the database and identifying patients at potential risk for adverse events.

As of 2014, notifications are presented in a format that enables the user to see the information ranked from high to low priority. When selecting a notification, the patient’s database report will be generated and sent to the clinician for evaluation. A reminder email will be sent if the clinician does not view the patient’s report. Studies have shown that this type of notification is an effective tool in identifying potential doctor shoppers.

The State Department of Health has begun to use the database to inform prescribers about their prescribing habits by sending letters to the top 50 prescribers of controlled substances and then requesting an explanation justifying the amounts prescribed.

The Department of Health is also working to improve information sharing across state lines. Tennessee borders eight states and crossing over state lines to obtain controlled substances is fairly easy.

Without having information from other state prescription drug monitoring programs, it is difficult to see the types of drugs that individuals are taking when crossing state lines. Today, the Department of Health is working with other states’ monitoring programs that are in close proximity to Tennessee and working to create a prescription drug alliance to share prescriber and dispenser information from each state’s prescription monitoring program

According to the report, there are changes that could further improve the utility of the database. First, continue to make technological improvements to enable the report data to be presented in more real-time and provide easier user access.

Secondly provide de-identified aggregate data obtained from the database for the purpose of education and outreach to go to both healthcare practitioners and the public. Lastly, develop memorandums of understanding between other states to help guide information sharing practices for information gained through prescription drug monitoring programs.

Aside from the need to make progress in improving the database, a smartphone app is needed that will provide prescribers automatic updates on milligram/morphine equivalents and other information.

Go to www.tn.gov.mental/prescriptionforsuccess to view the entire report.

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