Over prescribing of controlled substance medications and opioids is a topic of serious concern for medical boards. Inappropriate prescribing contributes significantly to the number of opioid-related drug overdoses and the incidence of addiction across the nation. Both state medical boards and the DEA are cracking down on inappropriate prescribing by physicians.
Combine this increased attention with the fact that
between 80 and 90 percent of practicing physicians lack sufficient opioid prescribing and addiction awareness training, it's clear why the number of disciplinary actions taken by state medical boards have escalated in the past few years. In Florida alone, the number of disciplinary actions taken by the Florida Board of Medicine
increased by more than 100 cases in 2011, jumping from 215 in 2010 to 332 the following year.
However, the topic of inappropriate opioid prescribing is not so simple. While most tend to think of opioid over prescribing as something doctors do intentionally, the truth is far more complex. When it comes to opioid prescribing and identifying addiction concerns, physicians must act both as doctor and detective, making judgement calls about the suitability of opioids and other controlled substances for any one patient.
While most doctors are trained to trust the patient, this training fails to properly prepare physicians for the brutal realities of treating a patient who suffers from opioid addiction. Poor medical record documentation, a lack of consistent protocols for assessing addiction, lack of utilization of a prescription drug monitoring program (PDMP) and the stress of a patient who is "demanding their pills" often leads physicians to a path of inappropriate opioid prescribing. These errors create a danger to the patient and increase the potential for the physician to be mandated into a prescribing course by the medical board. Physicians can also face revocation of their DEA licenses.
For physicians disciplined by the medical board for improper opioid prescribing and who have faced revocation of their DEA licenses, educational courses essential to reinstatement are crucial to getting their career back on track. To this end, detailed, hands-on experiential learning courses can be of huge benefit to disciplined physicians. More specifically, disciplined physicians need a program that provides an individualized review of their personal prescribing habits and offers tools and experiential learning opportunities to reinforce the new knowledge gained through participation in the course. The following text outlines how to assist physicians who are uncertain in their prescribing practices or who have been disciplined by a medical board.
About Opioid and Controlled Substance Prescribing Educational Courses
Not all educational courses are equal, especially when it comes to learning about controlled substances. While lecture-based programs work well for topics that a physician is already familiar with, or with topics that include light practical applications, a topic as complex as controlled substance prescribing requires more of an in-depth practical approach.
A hands-on experiential course is the ideal solution for physicians seeking to regain their DEA licensing or meet the requirements of a disciplinary action set forth by a state medical board. This type of course is not only reactive, but also ideal for physicians who want to proactively ensure that their controlled substance and opioid prescribing skills are up to date and consistent with current quality of care standards.
Some of the key features of a quality opioid and controlled substance prescribing course include:
Since the goal is to identify deficiencies in a physician's pool of knowledge, determining and targeting those deficiencies is one of the founding principles of quality educational courses. Assessment techniques such as record review are used to identify deficiencies and identify opportunities for improvement.
Using the results of an initial assessment, remedial education courses can develop personalized recommendations for change in prescribing habits based on the deficiencies found by the individualized assessment process. Such assessments, therefore, are valuable both for the efficacy of the program and for the self-awareness of the physician, as they give the physician an opportunity to refresh and solidify their weaker knowledge and skills. Assessments are then used again after the completion of the program to demonstrate the physician's mastery of the material.
Opioid and controlled substance prescribing is a multifaceted and complex subject, and remedial courses addressing this issue should reflect that fact. Re-education on the subject of controlled substance prescribing typically covers topics such as:
- The latest prescription and documentation guidelines and laws
- Current overdose and addiction statistics
- Practical aspects of controlled substance prescribing, such as when opioids should and should not be prescribed
- When alternative pain management options should be pursued
- How to avoid patients who are "doctor shopping"
These topics are presented both in lecture and discussion-based formats, allowing physicians to learn and think critically about the topics.
While lecture and discussion alone are fine teaching methods, quality remedial courses take that final step to solidify physician knowledge through experiential learning. The combination of discussion and the interactive learning gained through the use of standardized patients fleshes out the concepts presented in lectures. The utilization of standardized patients allows physicians to think critically and develop the practical skills necessary for managing patients who require opioids and controlled substances.
An example of this kind of educational course is the one created and developed by LifeGuard.
LifeGuard combines lecture and discussion-based learning with practical applications needed to solidify knowledge. The course employs several lectures and discussions about the complex role of opioids in the medical field, followed by the use of standardized patients to reinforce learning. The program also utilizes a process to review individual prescribing habits of physicians before they arrive at the course. This review allows the faculty to pinpoint specific areas that may need a greater focus during the educational process. The combination of didactic and experiential learning methods ensures that physicians demonstrate their mastery of the material and identify practice changes specific to their prescribing patterns that indicated an opportunity for improvement.
Benefits of Remedial Educational Courses
The key aspects of the remedial educational course described above has real-world benefits for physicians looking to improve their current base of knowledge or seek reinstatement. Some of those benefits include:
The hands-on experiential learning aspect of a quality remedial course like the one offered by LifeGuard allows physicians to actively practice the skills they learn through the course. Instead of theorizing ways to apply their knowledge, physicians can instead solidify those applications through the use of standardized patient scenarios.
Each physician comes from a unique background, with a specific clinical focus and base of knowledge. This is why personalization is a key feature of any quality educational course. When it comes to the prescription of controlled substances, the level of knowledge varies from physician to physician, requiring programs to apply unique and individualized approaches. LifeGuard does this by providing a review of medical records provided by the physician to pinpoint specific areas for improvement and reinforcement.
The goal of any educational course is to provide physicians with the knowledge they need to get back into the medical field, though some physicians require more assistance than others. Personalization can help physicians identify and work on their most problematic gaps in knowledge, but responsiveness from the program itself can help guarantee that physicians with specific needs get the attention they require. This is why LifeGuard has a dedicated team of professionals available to help physicians and provide assistance for program participants through efficient communication.
When a physician has a disciplinary action from a state board that requires ongoing monitoring post the educational course, LifeGuard offers practice monitoring for opioid and controlled substance prescribing to ensure that the knowledge gained by the physician is incorporated into the physician's daily practice habits.
While these benefits and features are helpful for physicians going through remedial educational courses, one thing to keep in mind is that
completion of such a course does not guarantee favorable action by a licensing board. While the skills and knowledge gained through completion of the LifeGuard Opioid and Controlled Substance Prescribing Course or other programs can be of benefit to physicians seeking reinstatement, future reinstatement or employment is singularly controlled by the licensing board and/or the employer.
Developing a Prevention Plan
One of the most important skills taught in an opioid and controlled substance educational course is prevention. Utilizing appropriate documentation methods and avoiding over prescribing is the best way to avoid disciplinary action from a medical board. To that end, practicing physicians must develop and implement effective screening and documentation protocols with the intent to avoid over prescribing controlled substances. Key components of a prevention plan include:
Utilization of the PDMP:
A prescription drug monitoring database is one of the most important tools physicians can use to avoid over prescribing, especially when it comes to the issue of "doctor shoppers." Utilization of the PDMP allows a physician to see reports on both new and existing patients, including statistical and historical information regarding patient prescriptions and prescription usage. This is an important tool for verifying patients who have exhibited red flags during screening or examination.
Screening patients is another important step physicians must take to filter out prescription drug abusers. Such screening procedures should be applied to any patient seeking prescription drugs, whether they are a new or existing patient. These screening procedures should document any red flags the patient exhibits, such as visiting numerous physicians within the last few years, refusal to seek or try non-narcotic treatments, or specific requests for narcotics too quickly in the examination process.
Screening processes should also require a brief review of patient records to analyze past behaviors, such as previous narcotic prescriptions or prescription refill patterns that are too frequent. While some of these behaviors can be explained by human foibles, physicians should use their best judgement when screening patients for a potential narcotics prescription.
Before prescribing any opioid or controlled substance, physicians should perform a complete physical examination of the patient seeking them. Such examinations should be accompanied by meticulous documentation and notes within the patient chart. Such documentation is necessary for a physician to justify their decision if a medical board later questions the physician's prescribing practices. Even if the patient seeking an opioid or controlled substance prescription is a long-time recurring patient, physicians must avoid prescribing without performing a physical exam first.
Even a physician's memory is not perfect. Physicians should keep meticulous notes of patient examinations, prescription decisions, and prescription dispensation records. These notes should include detailed descriptions of anything related to opioid and controlled substance prescription, such as examinations performed on patients before the prescription, an assessment of the patient's symptoms or pain, and any red flags the patient exhibited, accompanied by the physician's reasons for dismissing them, when applicable. Any of these notes can serve as evidence to a medical board if a physician's prescribing practices come into question.
The skills necessary to develop and implement such a prevention plan can be developed and strengthened using a remedial educational course targeted at controlled substance prescribing, such as
How LifeGuard Helps
LifeGuard is a nationally recognized clinical skills assessment program supported by the Foundation of the Pennsylvania Medical Society. The program uses a custom approach for each registered participant, with a vast cache of targeted assessment tools to assess clinical competence and identify recommendations for improvement. LifeGuard specializes in re-entry, late-career physician assessment, and assessment related to a specific cause for clinical concern. LifeGuard offers several educational courses for physicians, including the Controlled Substance and Opioid Prescribing Educational Course. This LifeGuard course seeks to teach physicians about best practice opioid and controlled substance prescribing patterns and provide them with the skills necessary to improve their practice patterns.
Some of the goals of the LifeGuard Controlled Substance and Opioid Prescribing Educational Course include:
- Describing the nature of chronic pain, its potential causes, and options for its treatment.
- Understanding opioid prescriptions, the benefits and dangers of opioid prescription, and how to identify appropriate candidates for opioid prescription use to manage chronic pain.
- Recognizing the importance of screening before prescribing opioids and understanding how to design and implement a time-efficient method for risk screening.
- Recognizing and managing appropriate documentation parameters for controlled substance prescriptions, specifically pertaining to treatment goals, pre-prescription screenings and examinations, prescription dispensation patterns, etc.
- Understanding the new CDC guidelines on opioid analgesic therapy and prescription practices.
- Understanding DEA regulations for prescribing controlled substances.
- Learning how to monitor a patient's response to opioid therapy, including the usage of evidence-based methods to determine the efficacy of opioid therapy.
- Understanding the importance of documentation and medication reconciliation at each visit.
- Utilizing PDMP when prescribing opioids or handling problematic patients exhibiting patterns of potential controlled substance abuse.
- Recognizing problematic drug-taking behaviors and patterns.
- Distinguishing unintentional misuse or chemical coping from deliberate misuse, abuse, addiction or diversion in patients.
- Approaching problematic drug-taking behaviors in patients, including methods to determine whether to adjust opioid dosages, discontinue opioid therapy, or refer the patient to a specialist.
- Determining when to direct a patient to an addiction treatment program.
Learn More About LifeGuard
LifeGuard is a nationally recognized program administered by the Foundation of the Pennsylvania Medical Society, a 501(c) (3) incorporated not-for-profit entity. The program was conceptualized by the Pennsylvania Medical Society, a professional association for Pennsylvania physicians and physician assistants since 1848. Headquartered in Harrisburg, Pa., the Pennsylvania Medical Society and its Foundation seek to support both patients and physicians alike by providing resources for medical professionals across the state, including LifeGuard.
The purpose of LifeGuard is to provide an unbiased assessment process and pathway for physicians lacking in their clinical skills to update their knowledge to fit current standards. LifeGuard is renowned for its comprehensive approach to clinical skills assessment, attention to the individual needs of the physician and responsiveness to both physicians and other stakeholders seeking LifeGuard services. The program includes multiple pathways for physicians with particular needs. This includes the Re-entry/Re-instatement pathway for physicians seeking re-instatement after an absence or disciplinary action. LifeGuard understands the unique needs of its multiple constituencies and works seamlessly with state licensure boards, attorneys representing physicians, employers, Physician Health Programs and most importantly, physicians themselves.
For more information about LifeGuard's Re-entry and Re-instatement pathway or about the
Controlled Substance and Opioid Prescribing Educational Course, please call (717) 909-2590, or email info@LifeGuardProgram.com.