The opioid epidemic has been a prominent talking point in many circles lately, including physician groups, Congress, and, of course, the pharmaceutical industry. There are many possible solutions coming out of these discussions, including ideas like: public health surveillance, provider education, prescribing guidelines, community-based drug abuse prevention programs, regulatory oversight, and prescription drug monitoring programs.
Shatterproof, a national organization that is "committed to preventing substance use disorder and facilitating access to evidence-based treatments without shame or stigma for those afflicted," believes that one solution to this problem is the design, enactment, and effective utilization of Prescription Drug Monitoring Programs (PDMPs).
What is a PDMP?
A PDMP uses a statewide electronic database to collect designated data on controlled substances that are dispensed within the state. When properly utilized, PDMPs can identify and prevent drug misuse or diversion, identify polypharmacy, and offer treatment to patients in need of support, while continuing to ensure the legitimate medical use of painkillers. The data may also be more broadly used to analyze prescribing patterns and trends in use, ultimately informing patient-centered public health initiatives.
PDMPs have been around since the 1930s, when the concept was introduced as a paper-based database to track Schedule II drugs so that law enforcement officials could identify diversion. Many changes were made to PDMP regulations through the years, and in 2014, the Center for Disease Control and Prevention (CDC) began funding a Prevention Boost State Program to equip states with the resources and scientific assistance to prevent prescription opioid overdoses by addressing the inappropriate prescribing that fuels the epidemic. That program supports three key areas, including maximizing PDMPs.
To date, forty-nine states and the District of Columbia have enacted some form of legislation authorizing the creation and operation of a PDMP. However, in the majority of the states, according to Shatterproof, PDMP participation by prescribers is low, thereby compromising the effectiveness of this clinical tool.
Concerns over PDMP
Some express concern that PDMPs will eventually lead to limiting access to prescription opioids for patients in need. However, Shatterproof insists that is not going to happen. Shatterproof states that the objective is to protect patients from being prescribed opioids they do not need, in volumes that are unnecessary, or in combination with benzodiazepines. These three protections help minimize the likelihood for patients to develop an addiction to opioids, or result in death from an overdose.
How to Make PDMP Better
Shatterproof has analyzed PDMP practices and policies to identify a proven model for states to adopt. Through this guidance, states may enact state-specific legislation that has the potential to save lives of residents.
The twelve critical elements to effective state legislation and PDMPs are:
- Dispensers report specified information, quickly;
- Prescribers look at the PDMP before prescribing drugs in Schedules II, III, and IV;
- Licensed prescribers must register with PDMP;
- Delegation of PDMP data queries should be enabled;
- Specified recipients of PDMP data should be authorized;
- Proactively analyze and distribute PDMP data;
- PDMP data should be shared with other states;
- De-identified information should be provided;
- A community-based approach to PDMP data should be taken;
- Link PDMP data to pain and addiction treatment;
- Institute confidentiality protections;
- Track and report evaluation measures.
The Shatterproof report goes into further detail, even going so far as to recommend legislation and provide the rationale for the recommended legislation.