Managing Risks Associated with Doctor Shopping and Other Drug-Seeking Behaviors

Transcription

1 Managing Risks Associated with Doctor Shopping and Other Drug-Seeking Behaviors This educational call is sponsored by the Enterprise Risk Management Task Force. Thursday, April 11, :00 am 12:00 pm (Eastern Time) Presenter: Robyn Diaz St. Jude Children s Research Hospital Memphis, TN robyn.diaz@stjude.org 1

2 Overview Prescription Drug Abuse in the U.S. What is Doctor Shopping? Uniform Narcotic Drug Act Uniform Controlled Substances Act State Doctor Shopping Laws Prescription Monitoring Programs Managing Risks 2

3 Prescription Drug Abuse in the U.S. Increase in accidental opioid overdoses Prescription drug abuse increasingly common with teenagers Increasing number of overdose fatalities attributed to overprescribing 3

4 What is Doctor Shopping? Patient obtaining controlled substances from multiple health care practitioners without the prescribers knowledge of the other prescriptions Usually going from doctor to doctor (or to ER) in a short period of time Doctor shopping + overprescribing = dangerous combination 4

5 CME Requirements TN - Requires every physician to complete a 1 hour course in prescribing practices as part of mandatory 40- hour CME requirements every 2 years. OK has similar requirement to TN CA, WV both have pain management CME requirements 5

6 Uniform Narcotic Drug Act (1932) No person shall obtain or attempt to obtain a narcotic drug, or procure or attempt to procure the administration of a narcotic drug, (a) by fraud, deceit, misrepresentation, or subterfuge; or (b) by the forgery or alteration of a prescription ; or (c) by the concealment of a material fact; or (d) by the use of a false name or false address. (2) Information communicated to a physician in an effort unlawfully to procure a narcotic drug shall not be deemed a privileged communication. 6

7 Uniform Controlled Substances Act (1970) A person may not knowingly or intentionally acquire or obtain possession of a controlled substance by misrepresentation, fraud, forgery, deception, or subterfuge 7

8 State Doctor Shopping Laws CDC is excellent resource on state laws: g/laws/dr_shopping.html Don t forget Medicaid-specific provisions 8

9 Look at your state law: TN Example T.C.A T.C.A TN: Actual knowledge that a person has knowingly, willfully and with intent to deceive obtained or attempted to obtain a controlled substance -- Must report within 5 business days to local law enforcement. 9

10 Prescription Monitoring Programs 42 States currently have an operational PMP Pharmacists in states where monitoring programs exist are required to report controlled substance prescriptions. Prescribers may (and in some states, must) check the database before prescribing, or run regular DEA reports Alliance of States with Prescription Monitoring Programs: 10

11 TN CSMD 1/1/13 - Prescribers with DEA numbers who provide direct care to patients in Tennessee for more than 15 days per year had to register 4/1/13- Prescribers must check the database before prescribing an opioid or a benzodiazepine as a new course of treatment lasting more than 7 days, and at least annually thereafter Exceptions 11

12 Challenges of Databases Typically only authorized by law to run a search of your patient s information, not of a patient s family member. If you work in a multi-state/border area, you may have multiple state databases to check. Pharmacies that ship to multiple states have reporting requirements to multiple states. Operational burdens 12

13 Why Should Healthcare Providers be Concerned? Patient Harm Missed opportunity to treat possible addiction Liability risk (individual prescriber and institution) Reputational risk Overprescribing is of interest to law enforcement State licensing board actions (reportable to NPDB) DEA actions (reportable to NPDB) Criminal actions 13

14 Managing Risks Document exam and assessment before prescribing Keep good records Don t overprescribe (small quantities when possible) Discuss with patients importance of not sharing medications and of potential addiction 14

15 Managing Risks, Continued Look for red flags Pressure to prescribe a particular opioid Multiple increases for requests in pain meds No clear clinical explanation for pain level Rejects treatment aside from pain medications Personal or family history of substance abuse 15

16 Managing Risks, Continued Use pain management contract No alcohol or recreational substances Take all pain medications exactly as prescribed Do not attempt to obtain pain medications from another provider Require patient to use one pharmacy and bring bottles of pain medications to all visits Pain may be re-checked frequently Drug-screening tests? 16

17 Questions? 17

18 Managing Risks Associated with Doctor Shopping and Other Drug-Seeking Behaviors 2013 is published by the American Health Lawyers Association. All rights reserved. No part of this publication may be reproduced in any form except by prior written permission from the publisher. Printed in the United States of America. Any views or advice offered in this publication are those of its authors and should not be construed as the position of the American Health Lawyers Association. This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is provided with the understanding that the publisher is not engaged in rendering legal or other professional services. If legal advice or other expert assistance is required, the services of a competent professional person should be sought from a declaration of the American Bar Association 18