Managing the Risk of Prescription Drug Abuse, Essay Example

In making a potential diagnosis, the medical prescriber should be aware of two potential issues. The first issue relates to how the patient views him/her self, and what a potential diagnosis might mean for their future behavior and health. For example, an individual who has not thought of him/ her self of having a mental health problem may have difficulty with the diagnosis, and in some senses, that diagnosis might be self-fulfilling: someone who has marginal depression might allow that diagnosis to thoroughly influence their life including allowing that individual to cut themselves off further from society as a result of being “ill.”

The second main issue in diagnosis relates to the prescriber: That is, medical personnel bring in a raft of personal biases (relating to their own personal background and history), as well as biases from patients and experiences they bring into the current diagnosis. For example, if a medical examiner previously had a patient with similar symptoms, or saw something in a rare case that influenced their cognitive thinking, it might play a larger role than necessary in understanding the patient’s symptoms and ultimate diagnosis.

This is particularly true in the area of mental illness: That is, because there is no biological test or other means to “verify” (as of yet) that a mental illness biologically exists, medical personnel must depend on their judgment and past experience in understanding if a patient may have mental factors at play in their life. This may be particularly true if an individual is an addict or mentions there is mental disease in their family history. While there is a strong genetic component to mental illness in more severe diseases such as schizophrenia and bipolar depression, this is less the case in mild cases of depression that may be triggered by an external shock in an individual’s environment. Prescribers must be careful to balance what may be genetic factors leading to a diagnosis and the individual’s (in) ability to deal with temporary hardships. How to (ultimately) address these confounders in making an accurate mental health diagnosis is important, and must be handled through thoroughly examining the individual’s symptoms, as well as consulting others with the case specifics. As Saltzman et al. (2010) point out, diagnosis of mental disease must go beyond the mere “box ticking” exercise of using the diagnostic handbook and dig into other potential factors that may be leading to the symptoms. They posit that a doctor should be pay more attention in the diagnosis and dosage areas than other clinical doctors due to the complexities involved (

A prescriber, particularly in the area of psychotropic drugs, should assess the individual and the possibility of withdrawal symptoms before prescribing the drug. There are two potential cases where the prescriber should be particularly careful. The first is when an individual has a diagnosed mental illness and has addiction problems in other areas of his/her life including drug abuse, alcoholism, or other impetuous behavior that might signal an addiction (Woodward, 2010). This is because individuals with addiction may have physiological mechanisms in the brain that make them more probable to become addicts (Kailivas and Volkow, 2005).

The individual needs to know not only the risks of the medication, but also the problems that would occur from possible withdrawal. Indeed, looking at the current opiod addiction problem in the United States, a high percentage of abusers are those who tried to stop taking the pills after legitimate use and fell into illegitimate or abuse situations after they were unable to secure more prescriptions. Thus, a prescriber must be particularly careful in understanding the reason for the prescription and also the withdrawal symptoms that will accrue after. Webster and Webster (2005) provide one potential tool when they examine how a opiate pre-use test predicts whether an individual put on pain medication may potentially abuse it and put his or her health in danger. The use of these “pre-prescription” tools is an important first-line of defense in understanding what may happen with certain individuals using powerful drugs.

After a proper diagnosis is made and a choice of prescription ordered, there are limited, but important situations, where one would face professional liability. The first case is when the diagnosis is simply wrong: for example, if one is diagnosed with schizophrenia and put on extreme medication that ultimately leads to death, there will likely be a problem in that the diagnosis did not remotely fit the symptoms described by the individual. The second major case is when the wrong medication or dosage is prescribed for an individual. For example, if an individual was prescribed a medication he/ she was allergic to or was not an appropriate medication for the malady at hand, this would also lead to challenges for the prescriber. The third case in which this could happen .

Issues of liability have also been complicated by allowing different medical professionals the authority to prescribe drugs. Hooker et al. (2009) found that contrary to many expectations, nurse practitioners and physician assistants had fewer actions against them for liability actions regarding prescriptions. This is largely because although nurse practitioners and physician assistants are able to prescribe, the attending physician is also responsible for liability in the case.

References

Hooker, R. S., Nicholson, J.G., & Le, T. (2009). Does the employment of physician assistants and nurse practitioners increase liability? Journal of Medical Licensure and Discipline 95(2), 6-16.

Kalivas, P.W. & Volkow, N.D. (2005). A pathology of motivation and choice. The American Journal of Psychiatry, 162 (8), 1403-1413.

Saltzman, C., Glick, I., Keshavan, M. (2010). The seven sins of psychopharmacology. Journal of Clinical Psychopharmacology. 30(6), 653-655.

Webster, L.R. & Webster, R.M. (2005). Predicting aberrant behaviors in opoid-treated patients; preliminary validation of the Opiod Risk Tool. Pain Medication. 6(6), 432-42.

Woodward, B. (2012). Managing the risk of prescription drug abuse. Risk Management, 10(6).