title: Meperidine surveillance in an outpatient department: the recognition of misuse and its control.
abstract: The identification of two patients who were misusing meperidine prescribed in a hospital prompted the establishment of a surveillance system to examine the possible extent of the problem of prescription narcotic abuse. All outpatient prescriptions for meperidine in a six-month period were reviewed and 17 high users were identified who were considered to be at greatest risk of misuse; they received 55% of all meperidine dispensed from the OPD pharmacy. These persons obtained their prescriptions primarily through the emergency room, they rarely saw the same physician twice, and 12 of them carried a diagnosis of sickle cell disease. Among these patients, four cases of definite abuse were identified. Interventions aimed at promoting continuity of care to the high users led to a 66% reduction in meperidine prescribed to this group in the emergency room and to a shift in their care to the clinics. Establishment of a registry for narcotic surveillance is a first toward recognition of outpatient drug abuse. Limiting prescribing privileges to the physician responsible for a patient's long-term care can further decrease this risk.
mesh_terms: D004335:Drug and Narcotic Control; D006801:Humans; D008614:Meperidine / Q000627:therapeutic use; D009519:New York City; D010044:Outpatient Clinics, Hospital; D019966:Substance-Related Disorders / Q000517:prevention & control*
chemical_list: D008614:Meperidine