Question

You are a floater pharmacist working at a new pharmacy  on the weekend in the outskirts of an urban area. Towards the end of the day, Ben approaches your pharmacy counter with a new prescription for Percocet 10/325 #60 with directions to take 1-2 tablets every 4-6 hours as needed for severe pain from Dr. Stevens at the local urgent care facility. Ben states that he has just been in a multi-car accident, and is suffering from back and leg pain. Since he is a new patient, he is asked to provide more comprehensive medical information. In addition, a new state law requires prospective review of the prescription drug monitoring program (PDMP) before dispensing any opioid prescription. You complete review of Ben’s PDMP report (see below) and ask him about it. Ben reports that he has been working as a temporary concrete layer, and does not have benefits. He had been covered by Medicaid, but since moving to North Dakota, he hasn’t applied for it. He reports that he frequently experiences pain associated with his work. His medical information is below.

Age: 39 years

Past medical history: depression, anxiety, attention deficit disorder, alcohol use disorder, allergic rhinitis

Family history: mother (alive) with type 2 diabetes, depression, and hypertension; father (deceased) with history of alcohol use disorder, hypertension, cirrhosis

Social history: tobacco use (+); alcohol (+), living alone and not in the same city as the rest of his family

Medications: sertraline 50 mg daily; alprazolam 1 mg TID; cetirizine 10 mg daily (OTC)

PDMP Record:

Medication and dose	Instructions	Quantity (date)	Refills remaining	Prescriber	Pharmacy
hydrocodone/acetaminophen 7.5/325	1 tab every 4-6 hours prn pain	15 (10 days ago)	0	Smith	ABC
Hydrocodone/acetaminophen 7.5/325	1 tab q6 prn pain	30 (15 days ago)	0	Jones	123
Methylphenidate 10 mg	1 tab BID	60 (15 days ago)	0	Jones	123
hydrocodone/acetaminophen 5/325	1 tab every 4-6 hours prn pain	30 (20 days ago)	0	Hite	XYZ
Alprazolam 1 mg	1 tab TID	90 (20 days ago)	1	Hite	XYZ

14. Part II of this case study has explored options for controlling opioid misuse on the population and the individual level. Write a half- to one-page summary of the roles of the PDMP and screening using the ORT to reduce opioid misuse on an individual and a population level.

Answer 1

PDMP (Prescription Drug Monitoring Program) : Is highly effective tool utilized by government officials for reducing the prescription drug abuse and is among the most promising clinical tools to curb prescription opiod use.

Roles:

It is not just a monitoring system, but a dynamic and potential to address the broader issues of prevention, identification and treatment in real time.

It can provide a prescriber or pharmacist with important information regarding a patient's prescription history, helping to identify patients who may be misusing medications and at risk for overdosing due to co - prescribing.

It can help in identifying the high - risk patients and helps to intimate the immediate interventions and treatment.

It also can help federal, state and local officials identify key trends in both legitimate and problematic prescribing and dispensing , critical for tackling this nationwide crisis.

ORT ( Opioid Risk Tool) : ORT is a self - report screening tool designed for use with adult patients in primary care setting to assess risk for opioid abuse among individuals prescribed opioid treatment for chronic pain.

Patients categorized as high - risk are at increased likelihood of future abusive drug - related behavior. The ORT can be administered and scored in less than 1 minute and has been validated in both male and female patient's but not in non - pain population's.

The tool should be administered to patients upon an initial visit prior to beginning of opioid therapy for pain management. A score of 3 or lower indicates low risk for future opioid abuse, a score of 4 to 7 indicates moderate risk for opioid and a score of 8 or higher indicates a high risk for opioid abuse.

mark each box that implies. Female. Male

i. Family history of substance abuse.

Alcohol. 1 3

Illegal drugs. 2 3

Treatment drugs. 4 4

ii. Personal history of substance abuse

Alcohol. 3 3

Illegal drugs. 4 4

Treatment drugs. 5 5

iii. Age between 16- 45 yrs. 1 1

iv. History of preadolescent sexual abuse 3 0

v. Psychological diseases

ADD, OCD, bipolar, schizophrenia. 2 2

Depression. 1 1