Understanding the Logic Behind Prescription Drug Monitoring Programs

Prescription drug abuse is at epidemic levels in the country today, according to the Centers for Disease Control and Prevention (CDC), a federal agency that works towards the goal of improving overall public health in the U.S., including monitoring illicit drug use and abuse, in any form. They monitor prescription drug abuse using Prescription Drug Monitoring Programs (PDMPs), which are proving to be an effective way to identify which users are at risk for abuse.

Prescription Drug Monitoring Programs (PDMPs) are electronic databases operated and maintained by each state to track the prescribing and dispensing of controlled prescription drugs to patients. These drugs are subject to stricter government regulation due to their propensity to cause addiction. The databases are then used to monitor the information for suspected abuse or distribution into illegal channels. They can provide a prescriber or a pharmacist with critical information related to a patient’s controlled-substance prescription history, information that can help doctors and pharmacists identify high-risk patients who can avoid becoming addicted to painkillers via an early intervention, and outline drug use and abuse trends to inform and educate the public.

As opposed to drugs that are stolen from a pharmacy, for example, it is actually doctors who legitimately prescribe almost all of the prescription drugs that lead to overdoses. For this reason, the CDC has directed its attention towards preventing the divergence of prescription drugs after they are dispensed.

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Details of PDMPs

Prescription Drug Monitoring Programs

Prescription drug monitoring programs help prevent doctor shopping and prescription drug abuse.

PDMPs are organized and operated in a variety of ways from state to state. Each state chooses which of its agencies will house its PDMP, which controlled substances must be reported, who will be required to submit data, such as pharmacies, and how often they must submit it. Each state also determines who may access information in the PDMP database, such as prescribers, pharmacies or law enforcement, the reasons for which the information can be accessed; and what enforcement mechanisms are in place for noncompliance.

State regulations concerning PDMPs vary widely with respect to whether or how information contained in the databases is shared with other states. Sharing this information across state borders has become a top national priority. To this end, the federal Bureau of Justice Assistance (BJA) created a national Prescription Drug Monitoring Information Exchange (PMIX) Architecture, which helps states to remain flexible regarding changes in law and policy when implementing PDMPs. It also strictly enforces technology standards that ensure the privacy of exchanged information. Most importantly, the PMIX

Architecture enables nationwide information sharing while preserving states’ abilities to meet their own technology needs.

The PMIX Architecture supports and adheres to four primary tenets:

• The use of free, open and consensus-based standards

• Common formatting of shared data

• Security and privacy protocols to protect sensitive information

• Preserving states’ choices of interstate sharing solutions

While PDMPs may be effective in reducing the time required for drug diversion investigations, changing prescribing behavior, reducing “doctor shopping,” and reducing prescription drug abuse, they also can be the cause of unintended consequences, such as limiting access to medications for legitimate use or pushing illegal drug dispensing activities over the border into a neighboring state.

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How Clinicians Use PDMPs

The Office of National Drug Control Policy (ONDCP) advocates for prescription drug monitoring programs (PDMPs). They interviewed 35 clinicians from nine states about how they use PDMPs and how they are helpful to a clinician.

Clinicians described using the PDMPs mainly for clinical purposes, included verifying current prescriptions or prescription fill history. Participants also noted that they sometimes used the PDMPs for administrative uses, such as making sure no false prescriptions were written under their names.

One nurse practitioner in the interview reported using it to track the prescription drug use of any patient with a positive urine drug screen for benzodiazepines, opiates or barbiturates, for drug overdoses or chronic pain managed by prescription pain killers, muscle relaxants, barbiturates or benzodiazepines. Any behavior that might suggest a patient is dealing drugs, or “doctor shopping,” could also trigger a decision to check a PDMP, she said

Participants also reported using the PDMPs to coordinate care with other clinicians. Some PDMPs provide information about other prescribers, and participants would contact these clinicians to discuss treatment and prescribing plans and to obtain additional information when prescribing practices appeared inappropriate.

Participants identified pharmacists as key partners in handling PDMP information. The clinicians reported that pharmacists verified data in the PDMP report and call clinicians if they notice a patient using multiple prescribers for controlled medications, a questionable prescription dose, or suspected alteration.

Sharing PDMP Information with Patients

Participants reported sharing the PDMPs information with patients in different ways. For example, they reported discussing PDMP data with patients to help them understand what the information means and identify issues of potential addiction, for example, taking risky doses of controlled substances.

Clinicians said they also share the PDMP information with a patient is when it demonstrates the patient is engaging in suspicious practices, such as visiting several doctors over a short period of time for different pain medication. This also gives them the opportunity to address issues of potential addiction.

Once a clinician does shares PDMP information, patients may respond in a variety of ways. including being indignant, in denial, or trying to justify or rationalize their prescription histories. But being confronted with PDMP information sometimes can have the beneficial result of patients acknowledging a problem and requesting help.

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Barriers, Recommendations and Training for PDMP Use

One critical barrier to using the PDMP data to change prescribing practices is patient satisfaction ratings, such as Press-Ganey scores, a rating system that evaluates how doctors and other medical staff handle things like their decisions about whether or not to prescribe certain drugs to certain patients. Some organizations take these scores very seriously. Some clinicians believe that withholding narcotic prescriptions and taking the extra time to review PDMP data can worsen scores.

Another PDMP barrier noted by the group included a lack of training, noting that training is limited to how to access the system. Participants sought guidance on how to interpret findings, integrate the PDMP into workflow, or learn how to talk with patients about the results. Additional barriers to using the PDMP data included difficulty accessing and navigating the PDMP (e.g., time to run a patient query), and difficulty interpreting PDMP data for use in patient care. Delays in pharmacy reporting, data errors, and data gaps also were concerns.

the Take-Away

Prescription drug monitoring programs are state- and nation-wide programs that help doctors and authorities keep track of who is getting what prescription drugs, when, where, and from who.