Description of Strategy
Most states require some kind of physical assessment by a licensed practitioner (e.g. any person licensed, registered, or permitted to prescribe, dispense, distribute, or administer a controlled substance) to be completed before prescribing a controlled substance (CDC, 2015). This is typically in combination with obtaining informed consent from the patient, and often times, a written agreement outlining the patient’s responsibility.
Physical exams can be used both before prescribing opioids, and when prescription opioid misuse is suspected. As Dineen and DuBois (2016, p. 2) state, “physicians bear responsibility for careful and conscientious prescribing, which includes patient assessment, communication, and education.” In some cases, physicians can be fooled by “fake” complaints of pain, and a physical assessment decreases the possibility of misprescribing opioids (Jung & Reidenberg, 2007).
According to Section 2 (1) of the Wyoming Board of Medicine (Policy Number: 40-01) on February 13th, 2009, in order to prescribe narcotics, “a patient history and physical examination must be obtained, evaluated, and documented in the medical record. The medical record should document the nature and intensity of the pain, current and past treatments for pain, underlying or coexisting diseases or conditions, the effect of the pain on physical and psychological function, and history of substance abuse. The medical record also should document the presence of one or more recognized medical indications for the use of a controlled substance.”
Discussion of Effectiveness
There is little evidence concerning the effectiveness of physical assessments on decreasing opioid misuse or abuse.
Centers for Disease Control. (2015). Prescription drug physical examination requirements.
Dineen, K. K., & DuBois, J. M. (2016). Between a rock and a hard place: Can physicians prescribe opioids to treat pain adequately while avoiding legal sanction? American Journal of Law & Medicine, 42(1), 7–52.
Jung, B., and Reidenberg, M. (2007). Physicians being deceived. Pain Medicine 8(5), 433–437.
Wyoming Board of Medicine. (2009). Pain Management Policy.