Rebecca Cunningham is an emergency room physician at the University of Michigan with an expertise in substance abuse in an emergency setting. The views expressed are her own and do not necessarily represent her employer(s) or affiliated organizations.
As an emergency physician, I am often faced with a waiting room full of patients seeking relief from their pain. Recently, I met a woman, who I’ll call Nancy. I did not recognize Nancy personally, but her demeanor and personality made me feel like she could be my friend or neighbor.
Nancy came to the emergency room complaining of excruciating pain in her leg. She was cordial and kind and considerate of the treatment options I provided her. When I was preparing to discharge her, she requested a prescription for a narcotic medication to treat her continued pain. Based on my interactions alone, I did not suspect she was attempting to obtain a prescription for misuse.
The data, however, suggested, otherwise.
Before prescribing pain medication, I performed a routine query on Nancy in the Michigan Automated Prescription System (MAPS). As a personal rule, I universally review the MAPS system prior to writing all narcotic prescriptions.
To my surprise, I learned that Nancy had recently received a prescription for 30 tablets of oxycodone filled within the past seven days; she had obtained over 20 prescriptions for narcotics from at least four prescribing physicians within the past 12 months.
Nancy displayed classic signs of “doctor shopping” ‒ the practice of obtaining narcotic prescriptions from multiple providers rather than one provider who could manage her pain adequately and ensure that she wouldn’t develop a substance use problem.
The State of Michigan’s new MAPS system flagged this concern with overwhelming evidence, making it easy to identify the potential problem. Based on this information, I was able to ensure that Nancy left the emergency department, not with another prescription for Vicodin, but with a referral for substance use treatment.
MAPS is a vital tool that equips physicians with real-time patient data and recent drug request history. MAPS provides data on patients and prescribers and dispensers of potentially harmful schedule II-V drugs. The data in MAPS rely on the collective. When all health providers prioritize the use of MAPS to improve patient care, the aggregate data develops vital momentum to curb overprescribing to potentially vulnerable patients.
That’s why I supported recently passed state legislation which requires health care providers to check MAPS when prescribing more than a three-day supply of a schedule 2-5 controlled substance to a patient.
Without MAPS, I may have inadvertently furthered Nancy’s path of addiction and substance misuse. When we as physicians choose only to check MAPS on patients we feel are at high risk according to their medical history or exam ‒ we risk our own implicit bias driving our prescribing practices and, in doing so, put our patients and the community around our patients at a greater risk. To avoid this, a good practice is for physicians to check MAPS prior to prescribing discharge medications to patients.
The opioid epidemic in our communities does not discriminate by race or socioeconomic status. I have seen firsthand that this medical illness affects everyone ‒ rich, poor, rural, urban, educated and uneducated, young adolescents and elderly adults. Quite simply, utilizing MAPS for all patients ensures the best possible treatment that is both compassionate and data-driven.
Michigan’s new and updated MAPS system will only be effective if it is utilized universally by the physician and health provider communities. The use of objective data is the only way we as physicians can do our part to inform safe prescribing practices and reverse the opioid epidemic in Michigan.