The federal government should create an integrated data environment that brings together publicly available data with agency-specific data to help address the nation’s opioid epidemic.
That’s among the 56 recommendations made by the President’s Commission on Combating Drug Addiction and the Opioid Crisis in its final report released Wednesday.
In addition, the commission recommends a federal effort to strengthen data collection activities enabling real-time surveillance of the opioid crisis at the national, state, local and tribal levels, as well as reinstituting the Drug Abuse Warning Network (DAWN), a public health surveillance system that monitored drug-related hospital emergency department visits and was discontinued in 2011.
“Building a secure data foundation that promotes cross-entity collaboration while protecting privacy is a challenging but necessary step to save lives, expand treatment options and effectively prevent further spread of this deadly epidemic,” states the report. “The data exists but resides in agency silos, or in the private sector providing analytics for specific industries (e.g. pharmaceutical or healthcare insurers), making it difficult to act upon the information.”
The commission contends that creating such an integrated data environment “would not require a new data warehouse or standardization initiative” and that this kind of effort could immediately commence with the integration of existing data sources. Among the benefits of tapping into these existing data sources is that the information has multiple uses and can be leveraged by physicians, law enforcement, as well as public health agencies.
“Often, the same data viewed through a different lens can support multiple parts of the problem,” according to the report. “For example, doctors can use prescription drug monitoring programs (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.”
However, critics say that in the increase in the scope and number of PDMPs brings with it potential privacy risks. These state-run databases record a patient’s opioid prescribing history and are used by clinicians to flag suspicious activity as a kind of clinical decision support tool.
But, Leo Beletsky, associate professor of law and health sciences at Northeastern University, told a data privacy symposium hosted last week by the Department of Health and Human Services that the “emerging practice on the state level of bundling PDMP information with criminal justice data” is going too far. According to Beletsky, three states—Kentucky, Maine and Wisconsin—now include drug conviction information and drug charges (but no conviction) data in PDMPs.
“This begs the question: what does that provide for a healthcare provider and why is that (law enforcement) information bundled with your prescription information?” asked Beletsky. “PDMPs are decision support tools for clinicians and are supposed to help facilitate care coordination.”
The American Medical Association—the nation’s largest physician group—has advocated that PDMPs can be an effective clinical tool to assist doctors in making prescribing decisions. According to the AMA, physicians’ and other healthcare professionals’ use of PDMPs increased 121 percent from 2014 to 2016, and registration to use these databases nearly tripled during the same time period.
Nonetheless, according to the commission’s final report, 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 report makes several recommendations to “enhance the effectiveness and uptake” of PDMPs nationwide, including:
- PDMP data should be integrated with electronic health records, 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.
- The Office of National Drug Control Policy and Drug Enforcement Administration should increase electronic prescribing to prevent diversion and forgery. The DEA should revise regulations regarding electronic prescribing for controlled substances.
- The federal government should work with states to remove legal barriers and ensure PDMPs incorporate available overdose and naloxone deployment data, including the Department of Transportation’s Emergency Medical Technician overdose database.
Patrice Harris, MD, chair of the AMA Opioid Task Force, commended the President’s Commission on Combating Drug Addiction and the Opioid Crisis “for delivering a comprehensive report that provides an excellent roadmap for increasing access to medication-assisted treatment for patients with substance-use disorders and also demonstrates the need to eliminate barriers to accessing the full spectrum of multidisciplinary pain treatment options.”
The commission’s final report comes on the heels of last week’s announcement by President Trump declaring the opioid epidemic a national public health emergency under federal law and directing all executive agencies to use every appropriate emergency authority to fight the opioid crisis. Trump’s declaration specifically “allows for expanded access to telemedicine services, including services involving remote prescribing of medicine commonly used for substance abuse or mental health treatment.”
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