Date of Award

4-1-2006

Degree Name

Doctor of Philosophy

Department

Public Affairs and Administration

First Advisor

Dr. Peter Kobrak

Second Advisor

Dr. Keon Hyung L ee

Third Advisor

Dr. Karen Ogle

Abstract

The illegal use of prescription drugs and the under-treatment of chronic pain are both considered serious public health issues in this country. Strong medicines classified as controlled substances by the DEA are often used to treat chronic pain conditions and are also known to be diverted to non-medical uses, thus a solution to one problem may happen at the expense o f the other. Prescription Monitoring Programs (PMPs) are public policies that are felt by many to address diversion of controlled substances, and are generally welcomed by law enforcement as an excellent tool in the war against drugs. A number of pain management advocates, however, claim that the oversight included in PMPs discourages the prescribing of controlled substances by physicians and thus reduces the quality of pain management.

This study reviewed the effect of PMPs on drug diversion—as a subcategory of drug abuse—using a multiple regression analysis. Fifteen states were included in the regression statistics, seven of which had PMPs in place and eight states that operate without a PMP. The regression did not show a relationship between a change in the amount of drug diversion and the presence of a PMP.

The research also included a case study consisting of 30 in-depth interviews of physicians, pharmacists, and law enforcement officers, 15 in Michigan and 15 in Florida. The interviews provided professional opinions on what affects pain management and drug diversion, and the impact of PMPs on both issues. The case study generally supported the conclusion o f the regression in relation to the effect o f a PMP on drug diversion. It also provided additional insights into the best means of addressing a reduction in drug diversion and improvements in pain management. Education of clinicians and the general public was deemed critical by nearly every interview subject, as was attention to better and more accessible treatment for addictions. Physicians and pharmacists indicated they would welcome a prescription database as a patient-care tool if it were not accessible to law enforcement. All subjects seemed resigned to the presence o f drug abuse in our society, regardless of the nature of public policy. Reproduced

Access Setting

Dissertation-Open Access

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