PHARMACY NEWS

Utah Controlled Substance Database program Reminder (UUHP/HCU) 

The Utah Controlled Substance Database program (CSD) is a prescription monitoring program that is a resource for you to identify potential cases of drug abuse and over-prescribing. However, many prescribers are not accessing this valuable resource.

Reminder:

  1. According to Utah law, prescribers are required to check the database for information about a patient before the first time the prescriber gives a prescription to a patient for a Schedule II opioid or a Schedule III opioid.
  2. If a prescriber is repeatedly prescribing a Schedule II opioid or Schedule III opioid to a patient, the prescriber shall periodically review information about the patient in:
    1. the database; or
    2. other similar records of controlled substances the patient has filled.

For more information, see https://le.utah.gov/xcode/Title58/Chapter37F/58-37f-S304.html

Opioid Prescribing Guidelines - Best Practices (UUHP/HCU) 

Following evidence-based interventions may help with lowering overdose death rates:

  1. Avoid co-prescribing an opioid and a benzodiazepine
    1. Almost 1 in 3 opioid overdose cases involve a benzodiazepine; the combination may quadruple risk of fatality versus opioids alone.
  2. Minimize opioid prescribing for acute pain
    1. The Centers for Disease Control (CDC) recommends avoiding this combination whenever possible and advises that prescribers should carefully evaluate the risk versus benefit for patients currently on this therapy.1
  3. Taper opioids to safer doses-
    1. For patients who are currently receiving both benzodiazepines and opioids, it may be safer and more practical to taper opioids first. This is based on the greater risks of withdrawal when tapering benzodiazepines relative to opioid withdrawal and tapering opioids can be associated with increased anxiety.
    2. To taper opioid therapies, various clinical guidelines recommend reducing opioid weekly dosage by 10% to 50%. For patients with a shorter duration of opioid use, a dose reduction of 10% per week is a reasonable starting point. If patients have been taking opioids for longer durations (e.g. months/years) tapers at a slower rate, such as 10% per month, are likely to be better tolerated.
    3. If tapering the benzodiazepine therapy is desired, the CDC recommends a gradual taper (25% every 1-2 weeks) to avoid withdrawal symptoms. Additionally, Cognitive Behavioral Therapy can be a useful adjunct treatment for patients struggling with a benzodiazepine taper.
    4. Slow opioid tapers decrease and often eliminate withdrawal symptoms; slow benzodiazepine tapers help minimize withdrawal symptoms.
  4. Prescribe Naloxone
    1. The CDC recommends prescribing naloxone to patients on higher than 50 mg of morphine equivalents daily.

References:
Centers for Disease Control and Prevention (CDC, 2022), MMWR Recommendations and Reports Vol71/No. 3 - Clinical Practice Guideline for Prescribing Opioids for Pain.
Retrieved from https://www.cdc.gov/mmwr/volumes/71/rr/pdfs/rr7103a1-H.pdf