Tips from the director of Duke Health’s Medical Pain Service
This year, the NC Controlled Substances Reporting System (CSRS) will celebrate its 10th anniversary. The system is a valuable resource that can help prescribers monitor patient behavior and avoid issuing prescriptions to patients who may be abusing or misusing the medications. Yet CSRS remains an underused resource in NC, with less than half of prescribers with a valid DEA registration currently signed up for access. Forum editor Jean Fisher Brinkley asked Dr. Steven D. Prakken, director of the Medical Pain Service for Duke Health and an early adopter of CSRS, for his thoughts on why – and how – prescribers should use the system.
Q: How long did it take for you to fully incorporate CSRS into your patient care?
A: Probably about a year. It’s a process. The most important thing is not to give up. Of the patients dying from prescription opioids, 85 to 90 percent have obtained them from a physician, directly or through family members. You want to make sure you are not contributing to the
problem without knowing it.
Q: Many prescribers comment that they just don’t have time to add checking CSRS to the list of things they do before or during a patient visit. What do you say to people with this view?
A: That I understand. A lot of physicians don’t want to do another bloody thing. But they don’t have to–have someone else do it. One of the great things about CSRS is that you can delegate access. Assign a staff member to learn the system and do the queries for you. They can have them waiting for you in the patient’s chart.
Q: Some prescribers are aware of CSRS but aren’t sure how it can be used to improve the care they provide. Can you offer some guidance?
A: CSRS is designed to help me understand what other prescribers have done and what I have actually done with this particular patient. You know what you’ve prescribed, but do you know what the patient has actually done? For example, let’s say I authorize three one-month scripts. Are the scripts filled early? Does the patient fill one and then nothing for six weeks? You can start to see patterns and develop a better understanding of what’s actually occurring.
Q: Can you offer some specific advice about when prescribers should check CSRS?
A: The first time you write an opiate for a patient, you need to check CSRS. After that, at a minimum, check CSRS every six months. Every time I do a urine drug screen, I check CSRS – they go together. And finally, I check whenever my gut tells me to. It’s going to be different for every patient.
Mandatory Registration for CSRS
A 2016 state law will eventually require all licensees who hold a valid DEA registration to register for access to the NC Controlled Substances Reporting System. The requirement will not be in effect until DHHS makes technical upgrades and meets performance targets; however, NCMB encourages licensees to
register now.
Delegate access
NC General Statute 90-113.74 (c) 1 authorizes licensed medical professionals to designate a delegate who may retrieve NC CSRS data for review by the prescriber. Some basics:
• The delegate can be any licensed or non-licensed person who is supervised by the prescriber.
• The prescriber is responsible for all delegate ac-tivity
• Delegates may not use the prescriber’s login in-formation to access CSRS; They must have their own accounts.
