ACP policy paper calls for tighter management of prescription drugs

The American College of Physicians recommended 10 clinical and administrative changes that will make it harder for prescription drugs, such as those prescribed for pain, sleep disorders and weight loss, to be abused or diverted for sale on the street.

ACP's Health and Public Policy Committee developed the position paper to guide prescribers and policymakers faced with the challenge of deterring prescription drug abuse while maintaining patient access to appropriate treatment.

In a new policy paper that appeared online first on Dec. 10 in Annals of Internal Medicine, ACP strongly advocated for physician, patient and public education on the harms of medical and nonmedical use of prescription drugs. For the treatment of pain, ACP recommended that physicians consider the full array of treatments available before prescribing opioids.

While maximum dosage and duration of therapy limitations may not be appropriate for all patients, ACP recommended the establishment of evidence-based, nonbinding guidelines to inform treatment. ACP also supported the establishment of a national Prescription Drug Monitoring Program so that prescribers and dispensers can check with their own and neighboring states before writing and filling prescriptions for substances with high potential for abuse. Until such a program is implemented, ACP supports standardizing existing programs through the federal National All Schedules Prescription Electronic Reporting program.

Other recommendations include:

• a comprehensive national policy on prescription drug abuse containing education, monitoring, proper disposal and enforcement elements.
• efforts to educate physicians, patients, and the public on the appropriate medical uses of controlled drugs and the dangers of both medical and nonmedical use of prescription drugs.
• a balanced approach to permit safe and effective medical treatment using controlled substances and efforts to reduce prescription drug abuse. However, educational, documentation and treatment requirements toward this goal should not impose excessive administrative burdens on prescribers or dispensers.
• encouragement for patients identified as at significant risk for prescription drug abuse to participate in a drug monitoring program and undergo random drug testing. Physicians may be required to report suspected cases of drug abuse but should not be mandated to conduct random drug testing without the patient's consent. The financial cost of mandatory drug testing should be borne by the authority requiring the testing; neither the patient nor the physician should bear the financial cost of random drug testing mandated by a third-party authority.
• consideration of patient-clinician treatment agreements as a tool for the treatment of pain.
• electronic prescription for controlled substances in all states.