Meeting the Challenges of Ethical Prescribing.

TheNational Institute onDrug Abuse (NIDA) reports that more than130peopledieeverydayas a resultofanopioidoverdose. Drug overdoses now outpace motor vehicle accidents as the leading cause of accidental death in the United States, with 52,404 fatal drug overdoses reported in 2015, according to the AmericanSocietyofAddictionMedicine; 20,101of thesedeaths were attributed to prescription pain medication. Themortality and morbidity associated with opioid substance use disorders also pose a substantial financial burden. The Centers for Disease Control and Prevention (CDC) estimates that $78.5 billion is spent annually to respond to opioid misuse, addiction treatment, and related health care. Although addressing the opioid epidemic is of utmost importance, the numbers above do not provide a complete picture, as they do not address the issues associated with other drugs of potential abuse. Anxiolytics, such as benzodiazepines, stimulants, and sedatives, are also associated with addiction and abuse. According to the NIDA, an estimated 18 million people, more than 6 percent of those aged 12 and older, have misused prescription medications at least once in the past year, including opioids, stimulants, and sedatives. Although prescription drug misuse is only part of the story, a substantial number of those individuals who develop a dependency on drugs begin their journey with a prescription fromahealth careprovider. Provideroverprescribinghasbeen cited as a contributing factor to the current opioid epidemic. Many individuals who use illicit forms of drugs start on prescription therapies and then convert to drugs like heroin when they are unable to meet the financial burden imposed by having to purchase prescription drugs from other sources. Changing how and when controlled substances are prescribed can help to alleviate drug misuse and dependency. A provider’s first experience with prescribing begins during their education, suggesting that their habits, includinghowthey prescribedrugsofpotential abuse, also begin at the same time. Although not conclusive, a study published in 2018 linked a medical school’s ranking with the future prescribing habits of graduates, suggesting that schools with a lower ranking and perhaps less training regarding the appropriate use of opioids affected their graduates’ subsequent prescribing. In many cases, recommendations regarding treatment of acute pain do not have standardized prescribing guidelines for drugs associatedwith dependency. For example, surgeons report receiving little trainingduring their education regarding appropriate pain control post procedures, recently prompting medical centers, physician groups, and states to implement post-operative opioid prescription guidelines. There is clearly an incentive to positively affect prescribing habits early in a provider’s education to reduce the risk of tolerance and addiction in the future, especially for patient populations at risk and, subsequently, the associated legal and ethical implications of misuse. Implementing standards across the curriculum can achieve these needed changes in the education of physicians and physician assistants (PAs) alike.