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Friday, March 4, 2011

Primary Care Physicians Monitoring Patient Drug Use


Doctors have a huge responsibility to care for people who cannot take care of themselves. Primary care physicians prescribe medications that can be addictive, so it is up to them to monitor their patients and make sure that they are not becoming dependent on their medications. According to a new study conducted by the Albert Einstein School of Medicine of Yeshiva University, primary care physicians are doing an inadequate job of monitoring their patients' use of prescription narcotics. The study, published in the March 2 online edition of the Journal of General Internal Medicine, determined that overall doctors have been quite lax, even with patients who have a high risk of addiction and/ or struggled with addiction in the past. Prescription drug abuse now ranks second (after marijuana) among illicitly used drugs, with approximately 2.2 million Americans using pain relievers non-medically for the first time in 2009, according to the National Institute on Drug Abuse (NIDA).

"Our study highlights a missed opportunity for identifying and reducing misuse of prescribed opioids in primary care settings," said lead author Joanna Starrels, M.D., M.S., assistant professor of medicine at Einstein. "The finding that physicians did not increase precautions for patients at highest risk for opioid misuse should be a call for a standardized approach to monitoring." Researchers studied the medical records of more than 1,600 primary care patients who were receiving prescription opioids for chronic pain for an average of two years, placing emphasis on whether patients received urine drug testing, were seen regularly in the office, or received multiple early opioid refills. 8 percent of patients had urine drug testing and the rate of testing among those high-risk patients was still low at 24 percent, one-quarter (23 percent) of all patients received two or more early opioid refills.

Alarmingly, only half of patients were seen regularly in the office and patients at higher risk of opioid misuse were not seen more than patients at lower risk. "We were disturbed to find that patients with a drug use disorder were seen less frequently in the office and were prescribed more early refills than patients without these disorders," said Dr. Starrels. "We hope that these findings will call attention to this important safety concern."

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