5 Shortcomings You Need to Know About Prescription Drug Monitoring Programs (PDMPs)
Posted: February 8th, 2017 | Author: DoseSpot | Filed under: Basics, Controlled Substances, Public Policy | Tags: Addiction, Addiction Treatment, American Medical Association, CDC, Controlled Substances, DEA, Drug Diversion, e-Prescribing controlled substances, e-Prescribing State Law, EPCS, Maine State Mandate, Mandatory e-Prescribing, Mandatory Electronic Prescribing, PDMP, PDMP State Law, PDMPs, PMP, PMPs, Prescription Drug Abuse, Prescription Drug Diversion, Prescription Drug Monitoring Program, Prescription Drug Monitoring Programs, Prescription Monitoring Program, Prescription Monitoring Programs, State Law, State Mandate | No Comments »
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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: 3Â 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 effectâ€.
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;Â Wolters Kluwer; Shatterproof; National Center for Biotechnology Information
About DoseSpot
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