Prescription drug monitoring programs (PDMPs) can be an effective and valuable tool to help identify and prevent prescription drug misuse, however, in most states, prescriber participation is very low, which compromises the effectivness of the clinical tool, a new report states.
The report, released this week from Shatterproof, a national substance use disorder prevention organization, examines PDMPs and the critical elements of effective state legislation. The report calls on state legislatures to require doctors to use state-run databases to track patients’ history of opioid and sedative prescriptions in effort to address the growing opioid abuse problem in the U.S.
The report is timely given growing attention to the issue of opioid abuse in the U.S. Just this week, President Barack Obama spoke about the importance of tackling opioid abuse at the National Rx Drug Abuse and Heroin Summit in Atlanta, at the same time that his administration has issued proposed regulations and announced new funding for states to purchase and distribute the opioid overdose reversal drug, naloxone. This month, the Centers for Disease Control and Prevention (CDC) released prescribing guidelines to help primary care physicians safely treat chronic pain while reducing opioid dependency and abuse.
According to the report, prescription opioid consumption in the U.S. has quadrupled since 1999, and, according to the CDC, 30,000 people died from opioid overdoses in 2014 (18,893 from opioid pain relievers and 10,574 from heroin), up 14 percent from 2013. And, it’s estimated that 4.5 million people in the U.S. are addicted to prescription opioids
State leaders are increasingly establishing PDMPs to enable physicians to better track opioid prescriptions. A PDMP employs a statewide electronic database that tracks the prescribing and dispensing of controlled prescription substances.
In its report, Shatterproof recognizes the efficacy of PDMPs “when used appropriately” and outlines 12 best practices to guide state legislation. The organization urges states to optimize the effectiveness of their PDMPs by adopting the best practices, called Critical Elements of Effective State Legislation.
“When used properly, PDMPs identify and prevent drug misuse or diversion, identify polypharmacy and offer treatment to patient in need of support, while ensuring the legitimate medical use of painkillers. The data collected can also be used more broadly to analyze prescribing patterns and trends in use, and ultimately inform patient-centered public health initiatives,” the report authors wrote.
“PDMPs can help health care providers and pharmacists identify patients suffering from addiction,” Andrew Kolodny, M.D., executive director of the group Physicians for Responsible Opioid Prescribing, said in a statement. “Better utilization of this valuable tool can save lives.”
To date, 49 states and the District of Columbia have enacted legislation authorizing the creation and operation of a PDMP, however, the report authors state that in the vast majority of states, PDMP participation by prescribers is extremely low, and “the effectiveness of this clinical tool is therefore compromised.”
A 2015 study of primary care prescribers found that while a majority reported having obtained data from their PDMP at some point in time, prescribers consulted PDMP data in fewer than one-quarter of instances when they prescribed opioids to patients, the report stated. In a recent review of 2015 prescribing data in a sample of states where participation in the PDMP is voluntary, prescribers checked the patient history in the PDMP only 14 percent of the time before prescribing an opioid.
The report outlines three principals that states need to adopt in order to address prescription opioid abuse. First, each state must assure that its PDMP receives adequate funding. “In addition to state funds, federal funds that may be available include funding through the Centers for Disease Control and Prevention and the Harold Rogers PDMP Grant Program administered by the Bureau of Justice Assistance.”
Secondly, the report authors wrote, states need to assure that prescribers, dispensers and other healthcare professionals fully understand the appropriate uses of prescription controlled substances and the risks of misuse, abuse, addiction, overdoses and deaths involving these medications, how to intervene with persons who may be addicted, and how to refer such persons into treatment.
And, third, as the CDC issued the Guideline for prescribing of opioids for treatment of chronic pain, states should assure that healthcare professional licensing boards adopt these guidelines, that prescribers use these guidelines in their practices, and that the guidelines become the standard of care.
In the report, the organization analyzed PDMP practices and policies to identify a proven model for success and recommends 12 best practices for states to use in drafting laws in order to maximize the effectiveness of state-level PDMPs. The 12 best practices are:
- Dispensers report specified information expeditiously
- Prescribers query PDMP before prescribing drugs in schedules II, III and IV
- Licensed prescribers register with PDMP
- Enable delegation of PDMP data queries
- Authorize specified recipients of PDMP data
- Proactively analyze and distribute PDMP data
- Require interstate sharing of PDMP data
- Provide de-identified information
- Take a community-based approach to PDMP data
- Link PDMP data to pain and addiction treatment
- Institute confidentiality protections
- Track and report evaluation measures
With the second and third recommendations, specifically, the organization recommends that prescribers and their delegates be required to request and review a patient’s previous 12-month prescription history report prior to prescribing any drug included in Schedules II through IV of the Controlled Substance Act. The rationale, the report states, is that less than half of states with PDMPs legally mandate prescribers to query the system before writing for controlled substances.
And, the third recommendation, if followed, would require all prescribers with a U.S. Drug Enforcement Administration (DEA) or state-controlled substance registration number and al state-licensed pharmacists to register with the PDMP upon the initial registration or renewal of the prescriber’s professional license or certification.
“PDMP registration in conjunction with license registration and renewal will ensure prescriber compliance and reinforce the importance of the program. It also makes it possible for these healthcare providers to request data from their state’s PDMP,” the report authors wrote.
The organization also recognized state leadership in Kentucky, New York, Tennessee, Connecticut, Ohio, Wisconsin and Massachusetts for passing legislation capturing most of the elements in its 12 recommendations.
“Three states passed legislation in 2012 and 2013 which included many of the elements in Shatterproof’s Critical Elements of Effective State Legislation. It is important to note that as a result these states are seeing significant increases in PDMP use simultaneous with decreases in key indicators including doctor shopping, prescriptions for the most misused drugs, co-prescribing of opioids and benzodiazepines, and high risk prescribing of large dose opioids. At the same time, prescribing of buprenorphine, a medication used to help treat OUD, has increased,” the report authors wrote.
Kentucky, for instance, was the first state to mandate comprehensive PDMP use in 2012. And, according to data in the report, the state has seen a 13 percent drop in prescriptions of opioids dispensed, a 18 percent decline in prescriptions of sedatives dispensed and a 26 percent decline in prescription overdose hospitalizations after the program’s inception. There’s also been a 25 percent decline in prescription opioid deaths, the first decline in decades, the report states.
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