LAS VEGAS—Drug-induced deaths are now the leading cause of injury death in 17 states and the District of Columbia. In response to this crisis, 49 states and one territory had passed legislation authorizing Prescription Drug Monitoring Programs (PDMPs) as of January 2013, and 43 states had an operating PDMP.
What does this mean for the practicing clinician?
“PDMPs are tools that can potentially help track how medications are being prescribed and dispensed,” said Kevin L. Zacharoff, MD, FACIP, FACPE, FAAP, a clinical instructor at the State University of New York Stony Brook School of Medicine, Stony Brook, New York, and Vice President of Medical Affairs at Inflexxion, Inc., Newton, Massachusetts. “They are, at best, one tool in the toolbox.”
In essence, “a PDMP is a state-wide electronic database that gathers information from pharmacies on dispensed prescriptions for controlled substances,” he said, adding that states that permit practitioners to dispense also require them to submit prescription information to the PDMP. Although prescription data are made available upon request from end users and are sometimes distributed via unsolicited reports, “states vary widely in which categories of users are permitted to request and receive prescription history reports and under what conditions.”
Additional recipients of data may also include licensing boards, law enforcement and drug control agents, medical examiners, drug courts, criminal diversion programs, addiction treatment programs, public and private third-party payers, and other public health and safety agencies.
On August 27, 2013, the State of New York mandated use of its free program, I-STOP (Internet System for Tracking Over-Prescribing), requiring most prescribers to consult the Prescription Monitoring Program (PMP) Registry when writing prescriptions for Schedule II, III, and IV controlled substances, he said. “The registry provides practitioners with direct, secure access to view dispensed controlled substance prescription histories for their patients,” he said, adding the PMP is available “24/7” (https://commerce.health.state.ny.us). The reports include all controlled substances dispensed in New York State and reported by the pharmacy/dispenser for the past 6 months, allowing practitioners to evaluate their patient’s treatment with controlled substances “and determine whether there may be abuse or nonmedical use.”
Studies of PDMP use, for example, in an emergency department, found that 41% of cases had altered prescribing after the clinician reviewed the PDMP data: 61% of patients received fewer or no opioid pain medications than originally planned, with “39% receiving more opioid medication than previously planned because the physician was able to confirm the patient did not have a recent history of controlled substance use,” Dr. Zacharoff said.
A survey in Oregon found typical PDMP users to be emergency medicine and primary care clinicians and pain/addiction specialists. Among users, 95% reported accessing the PDMP “when they suspected a patient of abuse or diversion.” Fewer than half checked it for every new patient or every time they prescribed. “Nearly all users reported that they discuss worrisome PDMP data with patients,” Dr. Zacharoff said, with 54% reporting making mental health/substance abuse referrals and 36% reporting sometimes discharging patients from the practice. Those surveyed reported “frequent patient denial or anger.”
He concluded that more research on PMDPs is needed, including how they are incorporated into workflow and clinical decision making, what barriers exist, and how clinicians share results with patients.