Prescription monitoring programs crucial to fighting opioid epidemic

Experts view electronic databases as effective tools for physicians to see if patients have other orders for controlled substances, and wider use is urged.

Electronic databases that help states track controlled substance prescriptions are critical to reducing opioid prescribing, according to New Jersey Gov. Chris Christie, chairman of the President’s Commission on Combating Drug Addiction and the Opioid Crisis.

Testifying before a House committee hearing on Tuesday held in Baltimore regarding the Commission’s recent findings and recommendations, Christie told members of Congress that prescription drug monitoring programs (PDMPs) are among the most promising state-level interventions for flagging suspicious prescribing activities.

Christie said that PDMPs are not only effective law enforcement tools but are also aid physicians who can use the databases to see if a patient has opioid prescriptions from other doctors and “stop adding to the problem” of overprescribing of opioids.

“Often, the same data viewed through a different lens can support multiple parts of the problem,” according to the Commission’s final report released earlier this month. “For example, doctors can use PDMPs to check patient records, while law enforcement can use PDMPs to identify prolific opioid prescribers, and public health agencies can use it to identify and intervene in a potential victim pool before overdoses occur—different, but all valuable uses of the same data.”

The Commission’s recommendations called for more data sharing among state-run PDMPs, contending that the databases are being significantly underutilized in the vast majority of states. In addition, the panel’s final report noted that providers “often resist using PDMPs because these systems are not well integrated into the electronic health records (EHR) systems they currently use in practice, and for other reasons, including inadequate training on the use and complexity of some PDMP software programs.”

As a result, the Commission made several recommendations to “enhance the effectiveness and uptake” of PDMPs nationwide, including:
  • PDMP data should be integrated with EHRs, overdose episodes and substance use disorder-related decision support tools for providers to increase effectiveness.
  • Federal agencies should mandate PDMP checks.
  • The Administration should support the Prescription Drug Monitoring Act, which requires states that receive grant funds under PDMP or controlled substance monitoring programs to share data with other states, and directs the Department of Justice to fund the establishment and maintenance of a data-sharing hub.

Richard Baum, acting director of the Office of National Drug Control Policy, testified at Tuesday’s congressional hearing that the nation must maximize the use of PDMPs through better data integration and utilization, specifically calling out the Department of Justice’s Harold Rogers PDMP Grant Program, which provides resources to plan, implement and enhance PDMPs to prevent and reduce misuse and abuse of prescription drugs.

“PDMPs have great potential to aid in reducing the misuse and diversion of pain medications,” said Baum, who served as the executive director of the President’s Commission. “The government can maximize their use by continued support for federal programs like the Harold Rogers PDMP Grant Program and consider ways to increase PDMP participation by prescribers and pharmacists, and improve data integration and sharing.”

However, critics say that increasing the scope and number of PDMPs brings with it potential privacy risks. According to Leo Beletsky, associate professor of law and health sciences at Northeastern University, three states—Kentucky, Maine and Wisconsin—now include drug conviction information and drug charges (but no conviction) data in PDMPs.

Also See: Prescription drug monitoring programs come under fire

In Tuesday’s hearing, Christie specifically called out Missouri as the “worst state” in the country and the “sole outlier” when it comes to PDMPs.

“It is stunning to me that there is a state in this nation any longer that doesn’t have a comprehensive prescription drug monitoring program—and, that they’re not sharing that information with their neighbors,” said Christie. “We know that people will go from state to state to be able to fuel this addiction.”

In July, Missouri’s Governor Eric Greitens signed an executive order directing the Missouri Department of Health and Senior Services to begin work establishing a PDMP that will utilize de-identified data from private sector partners to specifically target “pill mills” and other bad actors to decrease opioid prescriptions.

Caleb Alexander, MD, co-director of the Center for Drug Safety and Effectiveness at the Johns Hopkins Bloomberg School of Public Health, told lawmakers at Tuesday’s hearing that providers should be required to use PDMP databases.

“To enhance the use of PDMPs, Congress should pass the Prescription Drug Monitoring Act of 2017, which incentivizes states to mandate PDMP use by linking such mandates to the receipt of federal funding to fight the opioid epidemic,” testified Alexander.

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