Download -full page

Developing Protocols for Controlled
Substance Medication Compliance
Presented to:
Metropolitan Drug Commission
February 10, 2015
Dan F. Sherrod, Jr.
CFE, LPI, CHSI, CPI, RSO, LAPPS
1
• I, Dan Sherrod,
DO NOT have a financial
interest/arrangement or affiliation with
one or more organizations that could be
perceived as a real or apparent conflict of
interest in the context of the subject of
this presentation.
Disclosure Statement of
Financial Interest
Disclosure Statement of
Unapproved/Investigative Use
I, Dan Sherrod, DO NOT anticipate
discussing the unapproved/investigative
use of a commercial product/device
during this activity or presentation.
Developing Protocols for Controlled
Substance Medication Compliance
• The approach you take with your patients with regards to
monitoring your patients for medication compliance will
set the tone for your practice.
• Patients who feel they are singled out for a drug test can
feel distrusted and discriminated against and may react
negatively.
• Patients within an upper socioeconomic and employment
status can be overlooked when deciding who to test.
Physicians often report that these patients can be trusted.
• When drug testing is presented in a uniform manner to all
patients, it is considered part of a routine.
4
Developing Protocols for Controlled
Substance Medication Compliance
DRUG TESTING ON INITIAL VISIT
• Establishes a baseline from which to evaluate the patient
• Corroborates what the patient has reported regarding
medications they are currently taking
• Identifies any medications patients may not realize are
still in their system
• Provides an understanding of all drugs the patient is
currently using that is necessary for effectively treating
the patient
• Helps increase patient acceptance as part of the routine
5
Developing Protocols for Controlled
Substance Medication Compliance
MATCHING MONITORING TO PATIENT RISK
• There are several risk assessment tools for clinical use to
assess for current or potential substance abuse.
• By triaging the patient population into low, medium or
high risk categories, the issue of discrimination goes away
and the level of care required for the patient can be
ascertained.
• If the practitioner chooses not to categorize the patients,
they can choose to test on every visit and also eliminate
patients concern that they are being singled out.
6
Developing Protocols for Controlled
Substance Medication Compliance
MONITORING ACCORDING TO
ABERRANT BEHAVIOR
• Another protocol that some practitioners use is to only test
patients who display aberrant behavior, such as lost
prescription or unsanctioned dose escalations and/or
concurrent use of alcohol.
• This type of monitoring can miss a significant number of
patients with substance use/abuse problems. It is
suggested that observance of these “RED FLAGS”
precipitate an additional drug test.
7
Developing Protocols for Controlled
Substance Medication Compliance
QUESTIONS FOR DEVELOPING A
PRACTICE-SPECIFIC MONITORING
PROTOCOL
1.
2.
3.
4.
Select a Risk Assessment Tool.
For Each Category, Decide # of Times a Year to Test.
Decide If You Would Test Every New Patient.
Would you like to have the observance of aberrant
behaviors (RED FLAGS) to trigger and automatic drug
test?
5. Would you like to test for anxiety and/or depression?
8
Developing Protocols for Controlled
Substance Medication Compliance
WHAT ARE SOME COMMONLY
OBSERVED RED FLAGS?
• Personal history of drug treatment, drug-related arrests, or
driving under the influence (DUI) or drugs or alcohol.
• Personal history of drug treatment, drug-related arrests, or
driving under the influence (DUI) or drugs or alcohol.
• Tobacco use.
• History of physical, emotional, or sexual abuse.
• Novelty-seeking/thrill-seeking personality.
• Knowing “too much” about different medications - opioids,
benzodiazepines, etc.
9
Developing Protocols for Controlled
Substance Medication Compliance
WHAT ARE SOME COMMONLY
OBSERVED RED FLAGS?
• Inability or unwillingness to obtain records
• Inability or unwillingness to produce urine for drug testing.
• Use of street drug vernacular such as “Oxy’s,” “Roxy’s,”
“bars,” “xanny bars,” “Dance.”
• Physical findings: drug-related tattoos, track marks, needle
bruising, “seed burns”, pupil dilation or constriction,
tachycardia, tachypnea, or hypertension suggestive of
withdrawal anxiety, lethargy, altered mental status, slurred
speech, and unsteadiness of gate.
10
Developing Protocols for Controlled
Substance Medication Compliance
• QUESTIONS?
11
Disclosure Statement of Financial
Interest
• I, Dan Sherrod, DO NOT have a financial interest/arrangement
or affiliation with one or more organizations that could be
perceived as a real or apparent conflict of interest in the context
of the subject of this presentation.
12