| One-Minute Clinician

Impacting Diverting: It Can Be Done

Jeremy A. Adler, MS, PA-C, of Pacific Pain Medicine Consultants, emphasizes the importance of the patient/practitioner conversation about the importance of drug safety. Communication and safety are key.

The argument that we need to educate providers more is an argument that could always be made: Who could not benefit from more education. The question is, are the problems that we are facing resulting from a specific lack of information or specific lack of certain types of information, and that’s not clear to me. I think that when you look at the issues of drug diversion, you may have a patient who’s been provided an opioid by a responsible provider for a patient who’s low risk, has a reasonable and appropriate indication, has been monitored with their urine drug testing in their states’ PDMP programs. You can do all of the right things for a patient; but if it’s sitting in their medicine cabinet in an insecure manner and somebody were to dip in to that, all of that is for naught. So you can educate the provider all you want but if the medication is diverted, that education is not going to result in a reduction in the harms, unless it’s an educational piece around diversion.

While diversion takes a couple of things, you have to make them less accessible; you have to have insurance companies willing to support smaller prescriptions; you have to incorporate technology like the abuse-deterrent formulations; you have to have lockable containers. There are many things that I think could help on the diversion side; but to blanket this and say that our providers in this country need more education as the solution, I would really argue what is it you’re trying to fix. I think of it like if a plane were to crash, you could say gosh, pilots need to go through another 2000 hours of flight training. Well if the problem was a bad screw, the education isn’t going to fix the negative outcome.

I think we have to be very tied between our problem and our solutions and make sure that those are intimately linked, not just come up with solutions that we think are good ideas or that are good sound bites. This is a complex problem. The solutions are going to be complicated and what fixes one problem won’t fix another. There’s not a one-size-fits-all result or approach that’s going to be successful.

I think diversion is really the area we have the greatest potential for impact. When you have the majority of people that are using opioids that are once prescribable, because now we certainly have an influx of opioids which are not prescribable but if they were prescribed I think that an educational piece – and we do this in our practice and we specifically set aside time to talk to our patients about how they store their medicine.

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