Refining Prescription Drug Monitoring Programs

(Spring 2015) States continue to refine their prescription drug monitoring programs (PDMP) to limit prescription drug abuse.  The goal for each state is that the medical professional will refer to and update data on patients’ prescriptions in order to minimize doctor shopping and abuse.

Each state has varying degrees of proactivity and participation and there are a multitude of measures and enhancements being explored for improvement.  Some states are looking at incentivizing physicians to participate.  Some are streamlining the enrollment process for physicians and pharmacy professionals and/or requiring them to register and actively use the system against specific criteria, e.g., within a certain number of hours after seeing the patient or upon renewal of licensure.  Some states are working to better educate medical professionals about the need and benefits of these programs and some are heightening threats of prosecution for non-use.  Some states are adding system features, e.g., automatic push notices against a patient name, dosage, multiple scripts, etc.

The evidence exists about the value of these programs in driving down abuse.  For example, Florida’s Annual Report demonstrated that more than 90% of the state’s pharmacies uploaded information to the system within the required timeframe, and requests for information from the database increased by 64% from 2013 to 2014 resulting in

• an 8.3% decrease in deaths caused by one or more controlled substance prescriptions
• a 53% reduction in the number of patients engaged in doctor shopping.

Unfortunately, according to a recent study funded by the National Institutes of Health, approximately one-third of doctor shoppers cross state lines to obtain prescriptions. While many states have instituted drug monitoring programs that track prescriptions within their borders few, if any, track across state lines. Some states are trying to address cross-border doctor shopping. New Jersey has entered into agreements with New York and Delaware to share information on prescriptions, and New England states have agreed to share data.

Some experts have called for a national prescription drug monitoring program. However, along with the routine complaints around electronic data including confidentiality and doctor-patient privacy, the centralization of data has evoked some concern.  For example, the Oregon Medical Association along with eight other state medical associations and the American Medical Association have concerns about federal drug enforcement of the state’s Prescription Drug Monitoring Program’s database. Amongst their concerns are the potential for re-purposing the database away from a public health tool toward a law enforcement resource for federal agencies.  Oregon Medical Association claims the DEA has tried to use its administrative subpoena power on multiple occasions to gain access to Oregon’s database.

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