Recently, the range of medically accepted alternatives to narcotics for pain relief has increased, Sorg says. Acupuncture, benzocaine and spinal treatments, relaxation and massage techniques, and physical therapy help with pain in some people.
“What we need is a broad approach to pain,” Sorg says. “We need to do a better job of discriminating people at risk for addiction and there are no good ways to do it now except by patient history. Genetics research is not there yet (to determine who is predisposed to addiction), but may someday help. We also need to work for better coordination of care. When multiple providers are involved — say, if a person who is vulnerable to addiction goes to a dentist and a knee surgeon — coordinating care becomes critical. That’s where prescription monitoring is helpful.”
In 2003–04, Maine implemented a Prescription Monitoring Program designed to prevent and detect prescription drug misuse and diversion. Overseen by the Office of Substance Abuse in the Maine Department of Health and Human Services, the database details all prescriptions for controlled substances dispensed in the state. The Prescription Monitoring Program includes an online service that allows prescribing clinicians and pharmacists to check the controlled substance treatment history for new and existing patients.
Sorg’s research demonstrates that, while healthcare providers in Maine write most of the prescriptions, many out-of-state healthcare providers (at least one in every state) are writing prescriptions filled in Maine pharmacies.
The research illustrates why policies involving prescription drugs can’t be done effectively by one state acting alone, says Sorg. State prescription monitoring needs some national coordination.
“It’s nearly impossible for providers to really know what their patients do with the drugs they prescribe. Some drugs are obviously being diverted,” Sorg says. “Doctors may develop suspicions when a patient is doing what is known as drug seeking (requesting prescriptions for increasing amounts or going from provider to provider to get multiple prescriptions). Patients may be harder to deal with if they become addicted and need opiates or they’ll go into withdrawal.
“The physicians caring for these patients are caught between a rock and a hard place. They want to do what is best for their patients, but sometimes find themselves having to deal with addicted patients who engage in illegal activities.”
The answer to the dilemma is multifaceted. It includes better patient education about the adverse effects of narcotics, prescriber education about effective ways to prescribe controlled substances, centralized prescription monitoring, and improved feedback to physicians and other prescribers about the problems of pharmaceutical abuse, Sorg says.
“Prescriptions are on the supply side for a lot of things that end up badly,” says Sorg. “Physicians and other prescribers need to pay attention to the downstream effects of prescribing. That includes being better informed if a patient is doctor shopping, using the Prescription Drug Monitoring Program, and doing better patient education and safer in-office prescribing practices.”