Your prescription; your responsibility
The Prescription Review Committee recently learned of a patient who received a single dispense of narcotics and sedative medications with a combined street value of over $17,000. Aside from the potential of accidental harm to the patient involved and to those with whom s/he lives, the situation presents a significant public safety risk—particularly when such large amounts of money are at stake.
Physicians can avoid putting their patients and the community at risk by practising pharmacovigilance. Pharmacovigilance means doing more than ensuring that the prescription one writes is therapeutically appropriate at the time it is given. It also means conducting the appropriate screening of the patient to minimize the kinds of problems that can emerge when at-risk patients are prescribed psychoactive or controlled medications.
Physicians can practise pharmacovigilance by taking a several important precautions:
- Remember that your prescription is your unique responsibility. The advice you receive from other physicians, even specialists, simply provides the context for your decision to prescribe.
- Do not prescribe potentially addictive medications to patients whom you have not screened for addictions or whose PharmaNet prescription profiles you have not reviewed. Even a brief screening can significantly reduce the risk of inappropriate prescribing.
- Learn whether the patients for whom you prescribe psychoactive medications drink, drive or perform safety-sensitive work, including caring for children.
- Pay close attention to the size and frequency of the dispenses authorized by your prescription. Unusually large or frequent authorizations can turn a safe prescription into a potentially hazardous one.
- Help to reduce the risk of medications being diverted by using treatment agreements, random pill counts, and urine drug testing where appropriate, for example, with patients on long-term opioid therapy.
The Prescription Review Committee provides additional information in its prescribing guidelines. Reviewing the guidelines while practising the five precautions above will help to protect patients and the community.
The Prescription Review Program (PRP) is a practice quality assurance activity established to assist physicians in the challenging task of utilizing opioids, benzodiazepines, and other potentially addictive medications with appropriate caution for the benefit of their patients. The work of the PRP is informed by the PharmaNet database.