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    Definitions matter: A taxonomy of inappropriate prescribing to shape effective opioid policy and reduce patient harm

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    Dineen_67UKanLRev961.pdf (3.200Mb)
    Creighton Authors
    Dineen, Kelly K.

    Admin. Units
    School of Law

    Subjects
    Opioids; Drug control--Government policy; Drugs--Prescribing

    Title
    Definitions matter: A taxonomy of inappropriate prescribing to shape effective opioid policy and reduce patient harm

    Authors
    Dineen, Kelly K.

    Journal
    University of Kansas Law Review

    Volume
    67

    Issue
    5

    Pages
    961-1011

    Date
    2019, June

    Metadata
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    Link
    Check for Full-Text (may not be available)

    Other Link(s)
    Library Catalog SSRN

    URI
    http://hdl.handle.net/10504/124377
    Citation
    Kelly K. Dineen, Definitions Matter: A Taxonomy of Inappropriate Prescribing to Shape Effective Opioid Policy and Reduce Patient Harm, 67 U. Kan. L. Rev. 961 (2019), reprinted in 2019 Health Law Seminar (Neb. Continuing Legal Educ. ed., 2019).

    Abstract
    To date, no existing law or policy defines inappropriate prescribing, with only one state acknowledging the need for such a definition. At the federal level, a single provision of the SUPPORT Act of 2018 directs the Secretary of HHS to define inappropriate prescribing in a narrow context. Despite the expanding number of opioid prescribing laws, policies, and guidance documents, words like overprescribing, misprescribing, and over-utilization are used in myriad contexts with implicitly different meanings. This paper argues that defining inappropriate prescribing is a necessary antecedent sanctioning it. It may also improve policy by correcting for bias and other decisional errors. Using legal and multidisciplinary research, a taxonomy of misprescribing is offered with the categories of inadvertent overprescribing, corrupt prescribing, qualitative overprescribing, quantitative overprescribing, multi-class misprescribing, and underprescribing. The later three categories are less commonly considered in policy decisions, despite long standing evidence of associated morbidity and mortality. Particular attention is devoted the underprescribing category, which includes the predictable response by some providers to discharge patients without referrals, blanket refusals to consider opioid therapy, and abrupt or too rapid discontinuation of opioid therapy after years of use. These decisions are increasingly associated with significant harms, including patient suicides and poisoning deaths after patients turn to illicit sources of opioids — harms that are usually ignored in policy and law. The modest goal of this paper is to offer an initial framework to guide development and evaluation of prescribing policies in alignment with existing evidence of harm.
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