Julie Worley

Prescription Drug Monitoring Programs, a Response to Doctor Shopping: Purpose, Effectiveness, and Directions for Future Research

Prescription drug abuse is a major worldwide problem and its incidence is on the rise, resulting in a huge societal cost. Prescription drug monitoring programs (PDMPs) are electronic databases that collect data on controlled substances so that health care providers can access the data and deter abuse, doctor shopping, and diversion. Currently only a few countries, including the United States and France, have operational PDMPs. The purpose of this paper is to review the literature on prescription drug monitoring programs. There is a paucity of research articles in this area; only 11 articles were published on this topic and relevant in the last ten years. Four themes were identified, (1) the effect of PDMPs on prescribing practices and the effect of PDMPs on the public, (2) the effect of PDMPs on prescribing practices and multiple provider episodes, (3) the effect of PDMPs on prescribing practices and characteristics of patients, and (4) health care professionals’ perspectives on PDMPs. Studies have shown that PDMPs decrease diversion and doctor shopping. Despite implementation of PDMPs, prescription drug rates for controlled substances and abuse rates have risen. There is an urgent need for understanding and research on this topic so that action can be taken.

Women Who Doctor Shop for Prescription Drugs

Doctor shopping is a term used to describe a form of diversion of prescription drugs when patients visit numerous prescribers to obtain controlled drugs for illicit use. Gender differences exist in regard to prescription drug abuse and methods of diversion. The purpose of this phenomenological study guided by the existential philosophy of Merleau-Ponty was to understand the lived experience of female doctor shoppers. Interviews were conducted with 14 women, which were recorded, transcribed, and analyzed. Included in the findings are figural aspects of the participants’ experience of doctor shopping related to the existential grounds of world, time, body, and others. Four themes emerged from the data: (a) feeding the addiction, (b) networking with addicts, (c) playing the system, and (d) baiting the doctors. The findings suggest several measures that nurses can take to reduce the incidence of doctor shopping and to provide better care for female doctor shoppers.

Promoting adherence to psychotropic medication for youth-part 2.

Failure to adhere to medication regimens can lead to unnecessary disease progression, disease complications, reduced functional abilities, lower quality of life, and even death. Medication adherence for children taking psychotropic agents poses many special challenges for health care professionals, as there is a little empirical basis for improving adherence. In Part 1 of this two-part series, the limited literature on the topic of psychotropic medication adherence for youth is reviewed.

Childhood Experiences of Perpetrators of Child Sexual Abuse

PURPOSE This study explored the childhood experiences of perpetrators of child sexual abuse. DESIGN AND METHODS A blend of narrative inquiry and phenomenology was employed. Interviews were conducted with 23 community-dwelling perpetrators (21 males, 2 females). The education of participants ranged from GED to PhD. FINDINGS There were four types of narratives: There Was No Love; Love Left; Love Was Conflated With Sex; and a Pretty Good Childhood. Chronic sorrow for a painful childhood was evident in most participants. PRACTICE IMPLICATIONS Cognitive-behavioral treatment may not be optimal for all perpetrators because it is not designed to facilitate recovery from early trauma and loss.

Recovery in Substance Use Disorders: What to Know to Inform Practice

Use of illicit substances and nonmedical use of prescription medication worldwide has increased dramatically in the past several years. Approximately 10% of people who use illicit substances will develop a substance use disorder (SUD). Similar to other chronic health disorders, periods of remission and exacerbation commonly occur in SUDs. Due to stigma and difficulty with definition, terminology related to SUDs has changed and evolved. Terms referring to nonuse of substances such as sobriety and abstinence are likely best replaced with the term remission. Similarly, the use of the term relapse, in reference to a return to use after remission should be replaced with the term exacerbation. Research and professional organization consensus indicate that after a period of five years of remission or recovery, the risk of exacerbation is low in SUDs. Recovery is a term used to describe overall improvements in quality of life during remission. Recovery has been defined by organizations and studied in research. Factors that have been shown to improve the success of recovery are increased quality of life, improved self-efficacy, employment, and spirituality. It is important for nurses to improve their understanding of the terminology related to SUDs and to communicate with others using the terms that are the least stigmatizing. Nurses are in a prime position to assess recovery and to help patients and their families implement changes in order to improve the success of their recovery.

Identification and management of prescription drug abuse in pregnancy.

Prescription drug abuse is a growing problem in the United States and many other countries. Estimates of prescription drug abuse rates during pregnancy range from 5% to 20%. The primary prescription drugs designated as controlled drugs with abuse potential in pregnancy are opiates prescribed for pain, benzodiazepines prescribed for anxiety, and stimulants prescribed for attention-deficit/hyperactivity disorder. Prescription drugs are obtained for abuse through diversion methods, such as purchasing them from others or by doctor shopping. The use of prescription drugs puts both the mother and the fetus at high risk during pregnancy. Identification of women who are abusing prescription drugs is important so that treatment can be ensured. It is crucial for healthcare professionals to use a multidisciplinary approach and be supportive and maintain a good rapport with pregnant women who abuse prescription drugs. Management includes inpatient hospitalization for detoxification and withdrawal symptoms, and in the case of opiate abuse, opiate maintenance is recommended for pregnant women for the duration of their pregnancy to reduce relapse rates and improve maternal and fetal outcomes. Other recommendations include referral for support groups and supportive housing.

Psychiatric Prescribers’ Experiences With Doctor Shoppers:

Doctor shopping is a primary method of prescription medication diversion. After opioids, benzodiazepines and stimulants are the next most common prescription medications used nonmedically. Studies have shown that patients who engage in doctor shopping find it fun, exciting, and easy to do. There is a lack of research on the prescriber’s perspective on the phenomenon of doctor shopping. This study investigates the experiences of prescribers in psychiatry with patients who engage in doctor shopping. Fifteen prescribers including psychiatrists and psychiatric nurse practitioners working in outpatient psychiatry were interviewed to elicit detailed information about their experiences with patients who engage in doctor shopping. Themes found throughout the interview were that psychiatric prescribers’ experience with patients who engage in doctor shopping includes (a) detecting red flags, (b) negative emotional responding, (c) addressing the patient and the problem, and (d) inconsistently implementing precautions. When red flags were detected when prescribing controlled drugs, prescribers in psychiatry experienced both their own negative emotional responses such as disappointment and resentment as well as the negative emotions of the patients such as anger and other extreme emotional responses. Psychiatric prescribers responded to patient’s doctor shopping in a variety of ways such as changing their practice, discharging the patients or taking steps to not accept certain patients identified as being at risk for doctor shopping, as well as by talking to the patient and trying to offer them help. Despite experiencing doctor shopping, the prescribers inconsistently implemented precautionary measures such as checking prescription drug monitoring programs.

Complementary Alternative and Integrative Treatment for Substance Use Disorders

Complementary alternative and integrative medicine (CAIM) modalities are increasingly sought after by patients with chronic health conditions such as substance use disorders (SUDs). Evidence suggests that CAIM interventions can improve symptoms commonly seen in patients with SUDs, such as stress, anxiety, depression, and pain. Mindfulness-based intervention (MBI), such as meditation, has proven effective for a variety of conditions, including SUDs. Other CAIM strategies, such as manipulative body practices and healing energy medicine techniques, are also showing some evidence of effectiveness. These methods center on the concept of restoring balance to energy fields or acupoints on the body, including chakras and meridians. Nurses are in an ideal position to educate, administer, and teach patients these CAIM methods to integrate with traditional medical care. Resources to learn CAIM methods can be accessed online, and specialized certification in this field is also available. [Journal of Psychosocial Nursing and Mental Health Services, 56(6), 16-21.].

Some Good News About Substance Use Disorders

Substance use disorders (SUDs) have reached epidemic proportions in the United States. The focus on the bad news related to SUDs can lead to a sense of hopelessness for nurses about identifying and managing these disorders. What is not as widely known is that there have been advances in several areas related to SUDs. This good news includes growing science about the neurobiology of these disorders and approaches to reduce stigma. In addition, there are known factors to improve success in recovery, such as improved quality of life, self-efficacy, and spirituality. Evidence-based treatments are also available for SUDs, including medications. Nurses should be aware of this good news about SUDs to maintain hope and integrate this knowledge into their practice. [Journal of Psychosocial Nursing and Mental Health Services, 55(3), 24-28.].

The Role of Pleasure Neurobiology and Dopamine in Mental Health Disorders

Recent evidence and research has demonstrated that the pleasure response and associated neurotransmitters and brain circuits play a significant role in substance use disorders (SUDs). It was thought that negative behaviors associated with SUDs resulted from negative choices, but it is now known that chemical changes in the brain drive those behaviors. Several mental health disorders (e.g., eating disorders, non-suicidal self-injury, compulsive sex behaviors, internet gaming, gambling) are also thought to involve those same pleasure responses, neurotransmitters, and brain regions. Studies have shown that the use of naltrexone, a dopamine antagonist, can reduce symptoms of these disorders. It is important for nurses to understand the underlying physiology of mental health disorders that are thought to have an addictive or craving component. This understanding can help reduce stigma. Educating patients about likely neurobiological causes for their disorders can also help reduce guilt and shame. Nurses should educate patients about these disorders and evidence-based treatments, including off-label use of naltrexone. [Journal of Psychosocial Nursing and Mental Health Services, 55(9), 17-21.].