From Our 2008 Archives

User Registry May Help Docs Stem Painkiller Abuse

THURSDAY, April 10 (HealthDay News) — Doctor's offices and clinics can help prevent the abuse of powerful narcotic painkillers such as Oxycontin or Vicodin by following a stricter policy — including urine testing — before dispensing the medications to patients, new research suggests.

Implementing a user registry and educating medical staff were also part of the procedures used in the University of Michigan/Ohio State University study. The policy helped identify patients using other illicit drugs and also alerted the staff to possible painkiller addicts who could then be directed to treatment facilities, according to the findings. The study was expected to be presented Thursday at the Society for General Internal Medicine annual meeting, in Pittsburgh.

In the study, which took place in a busy multi-physician clinic in Ohio, about 35 percent of the 167 patients in the newly established opioid registry were found to have violated the painkiller policy in some way. The most common violations were learned through a mandatory urine test that showed illegal street drug use, or a check of state prescription records that showed the patient was getting the painkillers from more than one physician at the same time.

Patients who were receiving Oxycontin or another medicine that contained its active ingredient, oxycodone, were twice as likely as other opioid registry patients to violate the clinic policy in some way, the report said.

"Many of us in the clinic were surprised at what we found, because a doctor's job is first and foremost to trust the patient as they tell us about their pain," study author Jennifer Meddings, a clinical lecturer in the Division of General Medicine at University of Michigan Medical School, said in a prepared statement. "But in order to confront this issue, and protect our ability to prescribe these drugs to the patients who truly need them, we need to have a uniform approach for all patients."

Under the policy used in the study, a registry of all patients receiving opioid prescriptions and their prescribing clinic physicians was established. Doctors in the offices were then trained on using the state of Ohio's online prescription database to see whether a patient attempted to get prescriptions for the same drug from several physicians or pharmacies.

Clinic staff began screening patients from the moment they called for an appointment, making them aware that monitoring was routine before they could receive opioid prescriptions. The patients, and also the doctors, were required to sign an agreement listing the standard steps required for patients seeking opioids and what types of behaviors or actions would result in the patient not receiving the meds or even being barred from the office (e.g., being abusive to staff).

Finally, the clinic implemented annual and random urine screening for all patients requiring opioids for non-cancer pain. This allowed them to monitor for illegal drugs and the unexpected use of other prescribed medications that could have dangerous interaction with the prescribed opioids.

—Kevin McKeever

SOURCE: University of Michigan, news release, April 10, 2008

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