A physician has raised concerns about risks to patients who are prescribed combinations of muscle relaxants with other central nervous system depressants and controlled drugs. Mixing these drugs can lead to potential harm.
The physician had treated a patient with a history of substance use disorder. The patient admitted that she “doctor shops” for baclofen prescriptions and visits multiple pharmacies for prescription renewals to try to prevent withdrawal symptoms.
The physician reported similar concerns about gabapentin being prescribed in combination with other drugs that increase patient risk.
Pharmacists and pharmacy technicians are reminded that not all drugs that have misuse potential are monitored by TPP Alberta, nor are they limited to opioids, stimulants, or benzodiazepines. Other drugs including muscle relaxants, gabapentin, and even antihistamines have the potential for misuse that could lead to serious adverse drug reactions.
Although the Guidance for Assessment and Monitoring: Individuals using Opioid Medications focuses on opioid drugs, the same principles and guidance in that document can be applied to patients using any drugs associated with misuse.
When filling prescriptions for medications associated with substance use disorder, note these important points:
- Netcare must be used routinely as part of the patient assessment, care plan, and follow-up. This Vital Behavior, originating from the Chat, Check, and Chart series, is an important step in providing optimal patient care.
- Collaboration with other health care professionals involved in the care of the patient is critical when real or potential misuse of the medication is identified. Ideally, the pharmacist will engage in dialogue with other providers where necessary to provide patient care and address concerns.
- Pharmacists and prescribers can always request a TPP Alberta profile if they have a patient for whom they have identified patterns or behaviours as concerning or high risk.
For further reading on this topic, CPSA has a case study of multiple prescribers of baclofen in their July 2020 newsletter.
