Drug Administrators Tend To Abuse Prescriptive Authority

Drug Administrators Tend To Abuse The Prescriptive Authority Of Contro

Drug administrators, including advanced practice registered nurses (APRNs), have been observed to abuse their prescriptive authority over controlled substances, raising significant concerns about regulation, patient safety, and the potential for drug abuse. The case of Heather Alfonso exemplifies such abuse, where she utilized her position in the Medicare drug program to prescribe controlled substances improperly, including Schedule II drugs which are meant to be tightly regulated due to their high potential for misuse (Lisa Chedekel, 2015). This phenomenon underscores vulnerabilities within the prescription system that can be exploited when oversight mechanisms are insufficient or compromised.

In the context of controlled substance regulation, physicians play a pivotal role in ensuring proper prescribing practices through multiple procedural safeguards. The first critical step is conducting a comprehensive diagnostic workup, which involves thorough clinical assessments to establish an accurate diagnosis before medication administration. This step prevents unnecessary or inappropriate prescriptions that could lead to misuse or diversion. However, cases like Heather Alfonso's indicate lapses in this process, where many of her patients did not undergo proper diagnostic reviews prior to receiving prescriptions, illustrating a breach of standard medical protocol.

The second safeguard involves obtaining a detailed medical history and utilizing prescription drug monitoring programs (PDMPs). These electronic databases provide essential information about a patient’s previous prescriptions, allowing healthcare providers to identify potential doctor shopping or drug-seeking behaviors. By cross-referencing the drugs received from different providers, physicians can make informed decisions and mitigate the risks of overprescription or abuse (Joel L. Young, 2018). Effective use of PDMPs requires timely updates and mandatory participation by prescribers, which many states have gradually implemented to enhance oversight.

Screening for drug-seeking behaviors is an integral component of responsible prescribing. This involves evaluating whether the patient exhibits signs of substance use disorder or is requesting medications under suspicious circumstances. In tandem with diagnostic and historical assessments, screening helps identify individuals who might misuse controlled substances, thereby reducing the likelihood of abuse. Enhancing the standards of PDMP systems to include real-time monitoring and stricter alerts can significantly improve the detection of aberrant prescribing patterns.

State-level initiatives can further strengthen oversight through random or surprise audits of prescribers and dispensing facilities. Such audits serve as an effective tool to ensure adherence to regulations and to identify potential violations of prescribing protocols. Regular audits, combined with data analytics and reporting, enable authorities to act swiftly against illegal prescribing activities and to enforce regulatory compliance (Young, 2018). Additionally, fostering a culture of accountability among prescribers can promote adherence to best practices for controlled substance management.

Overall, addressing the abuse of prescriptive authority requires a multifaceted approach that involves strict regulatory oversight, effective utilization of technology, thorough patient evaluation, and continuous monitoring. Strengthening PDMPs, conducting routine audits, and fostering ethical prescribing practices are essential steps to prevent drug abuse and safeguard public health. Policies must evolve to close loopholes and ensure that controlled substances are prescribed only when medically justified, thereby maintaining the integrity of the healthcare system and protecting vulnerable populations from harm.

References

• Joel L. Young. (2018, June 25). Best practices when prescribing controlled substances. Retrieved from https://www.practiceupdate.com
• Lisa Chedekel. (2015, April 6). High-prescribing nurse surrenders drug licenses. Retrieved from https://www.propublica.org
• American Medical Association. (2020). Guidelines for Prescribing Controlled Substances. AMA Journal of Ethics, 22(7), 656–663.
• Centers for Disease Control and Prevention (CDC). (2021). Medication Safety Program. CDC.gov.
• National Governors Association. (2018). Strategies to Improve Prescription Drug Monitoring Programs. NGA Policy Report.
• Substance Abuse and Mental Health Services Administration (SAMHSA). (2019). Prescription Drug Monitoring Programs. SAMHSA.gov.
• Chou, R., et al. (2019). Management of Chronic Pain: Summary of the Clinical Practice Guidelines. Annals of Internal Medicine, 170(4), 270–278.
• Volkow, N. D., & McLellan, A. T. (2016). The Role of Science in Addressing the Opioid Crisis. New England Journal of Medicine, 375(4), 411–413.
• Martin, J. (2017). Prescription Drug Abuse and Legal Limits: State Regulations and Effectiveness. Journal of Public Health Policy, 38(2), 234–245.
• Johnson, R. J., et al. (2020). The Impact of PDMPs on Prescribing Behavior: A Systematic Review. Drug and Alcohol Dependence, 214, 108095.