5 Shortcomings You Need to Know About Prescription Drug Monitoring Programs (PDMPs)

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Prescription Drug Monitoring Programs (PDMPs) are state-run electronic databases that are used to track the prescribing and dispensing of controlled prescription drugs with the intent of helping to detect suspected abuse or diversion. These electronic databases provide important information regarding a patient’s controlled substance history that can be accessed by authorized individuals or agencies including law enforcement, medical examiners, addiction treatment programs, public and private payers, pharmacies, healthcare providers, and more.

All states except Missouri, the District of Columbia, and Guam have enacted PDMP legislation that mandate healthcare providers to record, consult and monitor prescribing data. Since the widespread implementation of PDMPs and corresponding legislations, there have been stories and statistics that seem to indicate success, however, there has also been feedback that indicates some major troubles with these databases and their use.

With PDMPs being utilized all over the country, should we expect a major turn-around in the prescription opioid crisis that is sweeping the nation? Are these databases in fact doing the job that they are intended to do? Or, are there major issues that are preventing their success? Let’s explore together.

The Benefits of PDMPs

PDMPs are considered to be the most promising state-level interventions to improve opioid prescribing, inform clinical practice, and protect patients at risk. They are intended to not only medically benefit patient care, but also to serve as a tool for law enforcement and other agencies concerned with opioid-related threats to the public health. This is because the information entered in to a PDMP can help prescribers and pharmacists identify patients at high-risk who would benefit from early interventions.

Further evaluations of PDMPs have demonstrated changes in prescribing behaviors, the use of multiple providers by patients, and decreased substance abuse treatment admissions. From a public health standpoint, PDMPs can be used by state health departments to better understand the current opioid addiction epidemic to better create new intervention methods.

[Read: The Link Between PDMPs and e-Prescribing]

As an example, in 2010, Florida established a PDMP and prevented health care providers from dispensing prescription opioid pain relievers directly from their office. That same year, there was a 50% decrease in oxycodone overdose deaths in the state. This change is thought to represent the first documented, substantial decline in drug overdose mortality in any state during the previous ten years.

Likewise, in 2012, prescribers in New York and Tennessee were required to check the state’s PDMP before prescribing opioids and the following year, New York saw a 75% drop in patients “doctor shopping” and Tennessee saw a 36% drop.

The Unfortunate Reality of PDMPs

Although PDMPs have significant potential to improve public health and patient outcomes, they do have the following shortcomings:

1. Under-Utilization

The inconsistent use, or under-utilization, of PDMPs is considered to be the biggest issue plaguing the database, as a PDMP is most useful when queried before prescribing and most maximized where usage is state mandated. A recent survey found that with physicians prescribing in a state without a PDMP mandate, only 22% were aware of their state’s PDMP, and only 53% had actually used it. These facts clearly indicate that state legislation is a critical success factor for the effectiveness of PDMPs to save patient lives.

2. Lack of Accessibility

Another issue with PDMPs is the ease of use and access, or lack thereof. States vary widely in which user categories are permitted to request and receive prescription history reports and under what conditions. Research suggests that usage may improve if states were to allow providers to appoint non-prescribing staff members to access the database on their behalf.

[Read: 3 States Laying Down the Law on Opioids]

Furthermore, not all PDMPs share information across state lines. This can lead to important information being missed and can allow at-risk patients to receive more prescriptions for controlled substances than intended. However, more states are realizing the importance of sharing data across state lines and have recently become a part of PMP InterConnect.

3. Varying Times of Information Entry

Another matter of concern with PDMPs is varying times of information entry. When a controlled substance is dispensed to a patient, the prescription and patient information is entered by the pharmacy to the state PDMP. However, this information is entered at varying intervals – hourly, daily, or even monthly. If there is a long interval between dispense and submission times into the state PDMP, users will not have the most up-to-date information on a patient’s most recent prescriptions, thereby eliminating the maximum benefit of a PDMP. Currently, Oklahoma is the only state that collects data in real time, whereas, most states allow up to a week or longer for data submission.

4. Patient Adoption

Many prescribers attribute their worry about a patient’s reaction when checking the PDMP as a major disadvantage. In a recent survey, providers reported a variety of issues that arose when they reviewed the PDMP:

• 88% of patients reacted with anger or denial when questioned
• 73% of clinicians said that those angered patients sometimes did not return
• 22% of clinicians reported that the confronted patients had never asked for help with drug addiction or dependence problems

These clinicians also indicated that the unveiling of this information was not only upsetting to patients, and damaging to practitioner-patient relationships, but was also found to be inaccurate at times.

Additional concerns include added costs of more frequent office visits if prescribers become more cautious about writing prescriptions with refills, feelings of embarrassment when questioned about substance abuse, and patients turning to the illicit drug market if they are refused a controlled substance prescription.

Although the American Medical Association and American Society of Addiction Medicine stress the need to treat PDMP data just as well, if not better, than any other medical record, patients are becoming more vocal in their discomfort with PDMPs, claiming they make them feel that a medical consultation is no longer private.

5. Reluctant Prescribers

Like their patients, prescribers also show growing concern that they will be judged based on PDMP data. While most prescribers are assumed to support interventions to prevent fraudulent prescribing, high profile criminal prosecutions of prescribing large amounts of opioids can make prescribers reluctant to prescribe controlled substances in general for fear of legal retribution, also known as the “chilling effect”.

There is also greater perceived legal risk for prescribing or dispensing too much pain medication than for prescribing or dispensing too little pain medication. Because many practicing physicians have little if any formal training that would enable them to identify drug diversion, there is fear that PDMPs may wrongfully suspect and categorize some conscientious and caring physicians as fraudulent prescribers when they are actually prescribing in good faith, but lack training.

What Does This All Mean?

In this era of information technology, PDMPs are likely here to stay. While there are the aforementioned pitfalls of PDMPs, it is important to remember that there are still benefits to PDMPs in the public health sector, law enforcement, and of course, healthcare systems. What may be most helpful is to realize what changes could be made to make the PDMP process an ideal one.

From the standpoint of many prescribers, an ideal PDMP would:

• Alert its users to signs of illegal drug use
• Be easy to access
• Provide real time updates
• Be mandatory
• Have interstates accessibility

Perhaps over time if these changes were to be made, we would see more consistent use of PDMPs, especially as a tool to help overcome the opioid epidemic. A clear standard of practice against which providers’ care would be judged could also further advance the utilization of PDMPs in each state. Lastly, adequate training on addiction and pain management, along with a careful review of who should access a PDMP, could also attribute to better utilization and help accelerate the acceptance of each states’ prescription drug monitoring programs.

Author: Lindsey W.

Sources: Centers for Disease Control and Prevention; Lynn Webster MD; PDMP Assist; Wolters Kluwer; Shatterproof; National Center for Biotechnology Information

About DoseSpot

DoseSpot is a Surescripts certified e-Prescribing platform specifically designed to integrate with electronic health record, electronic dental record, practice management and telehealth software. DoseSpot is certified to e-Prescribe controlled substances and has provided simple, affordable and integratable e-Prescribing solutions to healthcare IT companies since 2009. For more information, please visit www.DoseSpot.com.

Overdose Awareness Day: The Time to Stand Together is Now

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International Overdose Awareness Day

To some, this day may not mean much, but to others, it is a day to commemorate and remember loved ones that we lost as a result of overdose. Unfortunately, these fatal occurrences are in large part due to a horrible, stigmatized and chronic illness: addiction.

While there has been widespread media attention for how addiction “should” be categorized as outlined in the latest New York Times article, addiction, specifically with opioids, is still viewed as a moral failing, a flaw, even. The associated stigma often deters patients from receiving proper rehabilitation treatment and even if they do seek treatment, the government currently limits the number of patients a single provider may treat with drugs such as buprenorphine or methadone, which are both proven to reduce cravings and save lives. This leads to many patients relapsing.

Physicians, internists, and dentists are collectively responsible for providing 81.6% of opioid prescriptions in the United States and because of this, they have a very unique role in mitigating the impact of this opioid epidemic. Opioid addiction often starts at the hands of healthcare professionals simply trying to do their job, prescribing pain medications to relieve their patients of painful woes, especially during post-operative recovery.

While many prescriptions are meant for initial, short-term treatment, some doctors and dentists authorize refills time and time again because they want to help patients whom claim that they are still in pain. However, when the pill bottle and refills run out, these patients are left high and dry; looking for alternatives to create that euphoric escape they’ve become so accustomed to. This could mean an endless search of several different doctors to prescribe more substances (also known as doctor shopping), purchasing pills on the black market, or worse, turning to heroin as a cheaper and more readily available alternative.

As the Surgeon General, Dr. Vivek Murthy, reiterates in his recent letter to all of America’s doctors, many prescribers don’t realize how dangerous the drugs can be, or even how addictive they are because many were incorrectly taught that opioids are not addictive when prescribed for legitimate pain. Dr. Murthy further points out that overdose deaths from opioids have quadrupled since 1999 and pain medication prescriptions have risen to the point that there’s enough for every American adult to have their own bottle of pills. It’s a fair statement that the majority of clinicians do not enter the healthcare industry with intent to harm their patients, yet it’s also fair to say that lack of proper education has further fueled these prescribing patterns.

So, who’s to blame here? Is it the prescribers? The pharmaceutical companies’ aggressive marketing tactics in the 1990’s? Learned behaviors? The demands and expectations from patients?

The truth of the matter is: no one is to blame. Blaming only diverts the necessary explication of collectively coming together as a nation to address this epidemic. The imperative solution is education.

Dr. Murthy also addresses in his letter that now is the time for clinicians to properly educate themselves on how to treat pain safely and effectively and screen patients for opioid use disorder and provide them with helpful resources and evidence-based treatment options. Furthermore, to shape how the rest of the country sees addiction, clinicians should shamelessly speak about it and start treating it as a chronic illness.

As a part of this ongoing education initiative, DoseSpot will be hosting a webinar in regards to the opioid epidemic that will include helpful tips and resources to stay ahead of this crisis. Stay tuned for more details.

Sources: Time; CNN; Time; Aetna; Surgeon General Letter; Shatterproof; CBS News

About DoseSpot:

DoseSpot is a Surescripts certified e-Prescribing platform specifically designed to integrate with electronic health record, electronic dental record, practice management and telehealth software. DoseSpot is certified to e-Prescribe controlled substances and has provided simple, affordable and integratable e-Prescribing solutions to healthcare IT companies since 2009. For more information, please visit http://www.DoseSpot.com.

Opioid Turmoil: Addressing the Link between PDMPs and e-Prescribing

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With a nationwide opioid epidemic upon us, states are starting to insist that prescribers conduct a bit of research before writing prescriptions for addictive medications like pain medications or benzodiazepines. States have therefore created statewide Prescription Drug Monitoring Programs (PDMPs) to monitor an individuals’ controlled substance dispense trends which are meant to assist a prescriber in making smarter treatment decisions. The goal here is to check a patient’s medication history to determine if the patient is doctor shopping or if they may have potential complications with medication(s) they are taking or have taken. Ultimately, PDMPs aid a prescriber in understanding the risks involved in prescribing these powerful medications for their patients.

“Databases known as Prescription Drug Monitoring Programs show doctors all controlled-substance prescriptions patients get and should be linked with the electronic health records (EHRs) that allow doctors to e-Prescribe.” USA Today

In most states, healthcare professionals who prescribe at least one controlled substance are encouraged, not required, to use PDMPs. The USA Today article addresses the fact that only five states promote the use of PDMPs and less than 20% of doctors use the databases when it isn’t required. On the other hand, e-Prescribing of controlled substances has proven to be an effective tool in combating this crisis, yet only three states have mandated the use of e-Prescribing, and one doesn’t enforce its own law.

Click here to learn more about e-Prescribing and how to stay ahead of this opioid crisis

All 50 States (and D.C) have now passed legislation allowing the e-Prescribing of both controlled and non-controlled substances, which is a drastic change from only a few years ago with federal regulations prohibiting the e-Prescribing of controlled substances.

Let’s take a look at the states that have mandated e-Prescribing:

New York: The first state to mandate and enforce its e-Prescribing laws as of March 2016, New York requires prescribers to check their state PDMP database and prescribers who continue to write paper prescriptions are subject to fines, jail time, or both. Since implementing, total numbers of opioid analgesics prescribed fell by 78%.

Minnesota: Technically the first state to deploy mandatory e-Prescribing, they currently do not enforce the use of such technology. The MN Department of Health recently reported that drug overdose deaths jumped 11% between 2014 and 2015 and more than half were related to prescription drugs, specifically opioid pain relievers, rather than illegal street drugs. Minnesota Health Commissioner Dr. Ed Ehlinger said, “The new data show the need for a broader approach to addressing the root causes of drug addiction and overdoses.” Stay tuned.

Maine: Experiencing one of the highest death rates in the country due to opioid overdose, Maine recently mandated e-Prescribing for schedule II controlled substances and will be put into effect come June 2017. Similar to New York, prescribers will face fines, jail time, or both if they choose to utilize paper prescription pads.

New Jersey is also on the horizon to mandate e-Prescribing in due time. As a collective nation, we can no longer sit back and overlook the link between opioid overprescribing and opioid overdose. E-Prescribing and PDMPs should work hand in hand; the benefits are exceedingly visible and with 3-9% of opioid abusers using forged written prescriptions, it’s a commonsense solution. Protect your company, protect your providers, but more importantly, protect your patients. They depend on it.

About DoseSpot

DoseSpot is a Surescripts certified e-Prescribing platform specifically designed to integrate with electronic health record, electronic dental record, practice management and telehealth software. DoseSpot is certified to e-Prescribe controlled substances and has provided simple, affordable and integratable e-Prescribing solutions to healthcare IT companies since 2009. For more information, please visit http://www.DoseSpot.com.