Controlled substance prescribing and education in orthopedic residencies: A program director survey.

BACKGROUND: Opioid misuse is currently plaguing the US. Efforts to reduce this include opioid prescribing education (OPE). Orthopaedic residents often prescribe opioids but, their education is unknown. METHODS: A survey was sent to orthoapedic residency program directors (PDs) regarding their program's controlled substance (CS) policies and knowledge of local CS regulations. RESULTS: There were 60 (36.8%) completed surveys. 54 (90.0%) programs allow resident outpatient opioid prescribing. Nine (16.7%) programs require individual DEA registration and 7 (13.0%) were unsure about DEA registrations. State laws regarding PDMP utilization and OPE for fully licensed physicians were correctly answered by 52 (86.7%) and 43 (71.6%), respectively. 27 (45.0%) programs had a mandatory OPE. Six (10.0%) PDs were unsure about a mandatory OPE. 16 (48.5%) programs that did not confirm an OPE were considering adding one. CONCLUSIONS: The majority of programs permit residents outpatient opioid prescribing; less than half provide mandatory OPE. Several PDs were unaware local CS prescribing regulations and education. This study demonstrates opportunities to improve OPE among orthopaedic residencies and PDs' knowledge regarding CS regulations.

Ensuring and Restoring Balance on Access to Controlled Substances for Medical and Scientific Purposes: Joint Statement from Palliative Care Organizations.

The central principle of "balance" represents the dual obligation of governments to establish a system of control that ensures the adequate availability of controlled substances for medical and scientific purposes while simultaneously preventing their nonmedical use, diversion, and trafficking, two primary goals of the international control system. On the one hand, although strong opioids, including morphine, are absolutely necessary for the relief of severe pain, legitimate access to opioids for pain treatment and palliative care is lacking in the majority of the world's countries. On the other hand, in a few high-income countries with higher consumption of prescription opioids, diversion and nonmedical use are increasingly prevalent. This report presents examples of unbalanced systems and a joint statement from global and regional palliative care organizations to promote development of balanced systems for optimal public health outcomes. Although nonmedical use of controlled substances poses a risk to society, the system of control is not intended to be a barrier to their availability for medical and scientific purposes, nor to interfere in their legitimate medical use for patient care. As representatives of palliative care organizations, we urge heads of state to act and to take measures to ensure and restore balanced systems in their countries and call on public health leaders and regulators to work together.

Prescripción de Drogas Controladas por Médicos Residentes del Hospital Central del Instituto de Previsión Social / Prescription of controlled substances by Internal Medicine Residents from the Instituto de Prevision Social

Los objetivos de este trabajo son: Determinar la prevalencia y tipo de psicofármacos recetados por los médicos residentes del Hospital Central del Instituto de Previsión Social (HCIPS), establecer la frecuencia con que se prescribe el psicofármaco, comprobar la correlación de familiares y profesionales consumidores de fármacos controlados y conocer la preparación académica legal sobre la prescripción de fármacos controlados por los médicos residentes del HCIPS. Se realizó un estudio prospectivo, descriptivo de corte transversal. Se estudiaron 100 médicos residentes del H.C.I.P.S seleccionados aleatoriamente. Los datos fueron obtenidos de una encuesta anónima. Se encontró que: 48% era de sexo masculino y 52% femenino, el 79% refirió recetar fármacos controlados y el 21% negó haber recetado fármacos controlados. De las respuestas afirmativas refirieron recetar benzodiacepinas 99%, antidepresivos 32%, opiáceos 10%, hipnóticos y antipsicóticos 61%. De los que negaron recetar psicofármacos sólo el 19% afirmó estar al tanto de la Ley del Control de Drogas en el país, a diferencia del 81% que no la conoce. De los que si recetan fármacos controlados sólo el 40 % conoce la existencia de la ley y el 60% la desconocen. De los que recetan, el 45% refirió tener al menos un familiar que consume regularmente psicofármacos a diferencia del 55% que negó tenerlo. El 9% de los médicos afirmaron consumir psicofármacos y el 91% niega su consumo. De los que recetan el 32% lo hace más de cinco veces al mes, 39% al menos una vez a la semana, 20% al menos una vez cada tres meses, 8% cada seis meses y 1% al menos una vez al año. Se concluye que los médicos egresados de las diferentes universidades omiten en porcentaje alto la observancia de las leyes y consecuentemente se encuentran expuestos a penalizaciones ante las transgresiones de las normativas vigentes. Palabras claves: Psicofarmacos, Prescripción, Fármacos controlados

The aims of this study are: determine the prevalence and type of psychopharmaceutical drugs prescribed by the residents at the Hospital Central of the Instituto de Prevision Social (HCIPS), establish the frequency of these prescriptions, look at the correlation between patients and health care providers regarding the consumption of controlled substances and to study the legal and academic preparation regarding this type of drug prescription by the medical residents of the HCIPS. This is a prospective, observational and cross sectional study. We randomly selected 100 medical residents from the HCIPS. Data was obtained from anonymous survey: 48% males, 52% females; 79% prescribed controlled substances and 21% did not. From the cohort that prescribed controlled substances: 99% prescribed benzodiazepines, 32% antidepressants, 10% opiods, and 61% hypnotics and antipsychotics medications. From the ones who refused to prescribe pshycopharmaceuticals, only 19% have knowledge about the "Controlled Substance Law" in Paraguay; 81% did not know about this law. From the ones who did prescribe these drugs, only 40% knew about this law and 60% did not know about it. Within the group that prescribed these drugs, 45% admitted that they have at least one relative that was using these drugs; 55% denies have any relatives using them. 9% of the physicians admitted to take these drugs and 91% denied their use. From the prescription group, 32% prescribe these drugs more than 5 times per month, 39% at least once a week, 20% once every three months, 8% every six months and 1% at least once a year. We concluded that physicians who graduate from different universities in Paraguay do not know about the laws related to controlled substances and they find themselves expose to be punish by breaking them. Keywords: psychotropic drugs, prescription, controlled drugs