Controlled Substances CME: Improving Patient Outcomes

Controlled Substances CME

The war on opioids in the U.S. has received its fair share of well-deserved attention over the last decade, and the healthcare industry has made tremendous strides in the name of patient safety. While this is not something to be underappreciated, much more work must be done. 

Prescription medication abuse and misuse are still running rampant across the nation, and while opioids are often the first type of medication that comes to mind, this is only one piece of the puzzle. The umbrella of controlled substances is broad, and prescription-related addiction can easily lead to more serious abuse issues. 

Controlled substances are not to be feared, but they must be respected. Medical providers exercising their privilege in prescribing controlled substances must do so responsibly to mitigate risk and optimize patient outcomes. As it often does, this begins with increasing awareness and knowledge and leveraging up-to-date information offered in controlled substances CME.

Controlled Substances Are More than Just Opioids

Controlled substances are medications primarily affecting the central nervous system and can cause a relative physical and mental dependence leading to addiction. Controlled substances that are regulated under existing federal law are classified into one of five schedules based on the substance’s medical use, potential for abuse, and safety or dependence liability.

When we think of controlled substances we often think about pain medications, which have long since solidified their place in our healthcare systems for easing the discomfort of patients with debilitating chronic or acute pain

We have come to learn that pain management is safest and most effective when prioritizing an integrated and ethical approach. The last thing we want to do is set the patient up for failure. Appreciating the short and long-term effects of opioids will keep prescribers and their patient on the right track, and there is a wealth of controlled substances CME that offers critical guidance about best practices. But what about other controlled medications? Controlled substances are being prescribed for things like anxiety, insomnia, and ADHD, and these medications can also lead to serious use complications. 

Benzodiazepines

Benzodiazepines are medications that depress the central nervous system (CNS) and are commonly prescribed in the management of conditions like anxiety, insomnia, and seizures. While the intended effect of CNS depression is effective in helping people feel less anxious or achieve better sleep, they are also associated with a high risk for dependency and misuse, particularly in patients with a history of substance abuse.

Benzodiazepines, especially those with a rapid onset, are often abused in a way such as crushing and snorting to create a euphoric effect. They are also sometimes taken inappropriately to manage side effects like irritability or agitation that are known to accompany the simultaneous abuse of cocaine or other stimulants.

Amphetamines

There are a variety of amphetamines prescribed in both active and inactive forms for the management of Attention Deficit and Attention Deficit/Hyperactivity Disorder (AD/ADHD). As a genuine stimulant, amphetamines can boost the levels of dopamine and norepinephrine in the brain and support the ability of our brain cells to work together, boosting energy, improving concentration, and helping people stay alert.

The misuse of prescribed amphetamines in ways like taking more than prescribed and diversion of medication to people without a prescription is not without risk. Unintended side effects like insomnia, weight loss, anxiety, high blood pressure, and tachycardia can be dangerous.

Sleep Aides

Many common medications that help with sleep also need to be monitored closely. Classified as sedative-hypnotics, these Schedule IV controlled substances are intended for short-term use in people having trouble maintaining normal sleeping habits. 

Abuse of these medications may include misuse or over-use leading to dependency, or diversion by selling the sleep aides to others.

Know the Issues and Improve Patient Outcomes

Without many of these medications, patients would be faced with challenges that could impact their health and their quality of life. However, while physicians can’t ultimately control what a patient does with these substances, there are many evolving prescribing practices that help mitigate the risks of addiction and misuse. Knowing the issues associated with controlled substances is the first step toward safety and helping patients stay ahead of any problems. 

Drug Diversion and Misuse

The act of drug diversion is the illegal distribution and use of prescription medications for purposes not intended by the person prescribing them. With motivation that can include relief of addictions, monetary gain, self-medication for pain or sleep, or alleviating withdrawal symptoms, misuse can include something as simple as altering the frequency in which the medication is taken or the form in which it is used.

Prescribers should be on high alert for potential diversion or misuse and implement tactics to limit the opportunity of diversion or misuse:

  • Identify patients who use or request combination or “layered” drugs for enhanced effects and use caution.
  • Maintain accurate records when prescribing, or choose not to prescribe controlled substances when other options are available (like a combination of non-addictive medications, therapy, and counseling about the patient experience).
  • Keep your DEA or license number confidential.
  • Use electronic prescribing to limit paper prescriptions.
  • Stick to strict refill policies.
  • Refer patients with the need for extensive pain management to specialized practices.

Use Prescription Drug Monitoring Programs

Prescription drug monitoring programs (PDMP) are electronic databases that track controlled substance prescriptions. PDMPs can help identify patients at risk for misuse and abuse by helping inform point-of-care clinical decision-making that improves patient safety. Clinicians should check PDMP data for prescription opioids and other controlled medications patients may have received from other medical providers:

  • When initiating opioid therapy for acute, subacute, or chronic pain.
  • Every 3 months or more frequently when continuing opioid therapy.

Support Proper Medication Disposal

Medications that are either no longer necessary or left over from previous use need to be disposed of properly. If not, they can easily end up in the hands of those they do not belong with or serve as a temptation for misuse and recreation. Prescription drugs should be disposed of according to federal, state, and local laws and regulations. Giving patients a secure and convenient way to get rid of medications can prevent diversion and abuse, as well as unintentional misuse like accidental overdose.

Help Improve Patient Outcomes with Controlled Substances CME

Responsible prescriptive practices related to controlled substances take a big bite out of an issue with many layers. While controlled substances represent an important healthcare resource, due diligence is needed to keep patients safe and improve patient outcomes. All prescribers need to stay up to date with current controlled substance practices, and as luck would have it Premiere has just what you need. With multiple courses covering prescribing practices like Safe Opiate Prescribing or Unlocking Effective Treatments - Pharmacology for Substance Use Disorder Continuing Education Course you’ll be familiar with safe and effective options.

When it comes to identifying those patients at risk, Teenage Turbulence - Screening and Treatments for Substance Use Disorder in Adolescents by Mary Ellen Biggerstaff DNP, MPH, FNP and Rhonna Nelson LMSW, ACSW, CAADC, P.C. will have you well prepared.

Controlled substances are not to be taken lightly, and the controlled substances CME available by Premiere will tell you what you need to know, giving you the knowledge and confidence to navigate difficult prescribing challenges. 

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