Based on a past study, overdoses from prescription drugs were greater than those involving heroin and cocaine combined.1 In 2013, more than 100 people died from opioid overdoses every day.2 How do we combat prescription drug overdoses, which are the leading cause of accidental deaths in the United States? Currently, the most popular initiative among policymakers is Prescription Drug Monitoring Programs (PDMPs). Recent data from Florida shows a decline in deaths caused by prescription drug overdoses and “doctor shopping” after the implementation of its PDMP and pain clinic law. Virginia also reported a drop in the number of doctor shopping after implementation. These are just a couple of states that have reported improvements. Additionally, data from the Centers for Disease Control (CDC) shows that overdose deaths due to opioid analgesics decreased by five percent from 2011 to 2012, the first decrease in a decade.3
PDMPs are a way to collect state-specified information from controlled substance prescriptions and make that information available to authorized users, which can help identify patients that may be diverting medications or abusing them. Most states have a delay in how often this information should be reported and there are often differences in what information is reported. Most states require the patient’s name and birth date. Any incorrect information generates errors when reporting to the state, and those errors must be resolved and the report must be resubmitted with the correct information. Right now, only one state, Oklahoma, reports in real time while most states are required to submit a report daily. Effective January 1, 2016, Illinois, Maine, Massachusetts, Nevada, New Mexico and Wyoming moved to daily reporting. Starting July 1, 2016, Utah and Connecticut will move to real-time reporting. Below is a map of the states which displays how often they require reports to be sent.
Date Delivered vs. Date Filled
Reporting changes are not the only big topic. Some states will be using date delivered as opposed to date filled. For example, if a prescription is filled and is never picked up, there is no need to report that prescription to the state, but once it is delivered, a signature is required and that signature triggers the prescription to be reported. New York and West Virginia are already reporting this way. Presently, 22 states require the patient to show some sort of identification at the point of prescribing and dispensing a controlled substance.
The PDMP process not only helps pharmacies and states but it also reduces drug investigation times. The Government Accounting Office reported that the average times for investigations of doctor shopping in Kentucky dropped from 156 days to 16 days after its PDMP implementation. The same report found a drastic drop, from 130 days to 20 days, in Nevada’s PDMP implementation and expenses related to investigations were reduced.5 When PDMP information is recorded and reported correctly, it drastically improves the efficiency of investigations. Below is a list of quotes from state agencies talking about the benefits of PDMPs.
- “As far as enforcement of the Controlled Substance Act, the Prescription Monitoring Program is one of the best assets we have ever had. The countless hours saved by the agents being able to pull the profile compared to the way agents used to have to go to each pharmacy to get a profile have saved the state a large amount of money in salaries and vehicle expense.” – Agent, Mississippi Bureau of Narcotics
- “This database is like cell phones and email – what the heck did we do without it?” – Ohio Narcotics Agency
- “After receiving a complaint, I can request a report and know in just a few minutes if there is a case to investigate or not…I cannot say enough about KASPER [Kentucky Prescription Drug Monitoring Program] and how valuable it is in my day-to-day investigations. If you, as an investigator, are not utilizing KASPER, you are limiting your resources and missing valuable information.” – KY State Police officer.6
Improvements Still Relevant
Even with all the positives, patients can still deceive the effects of PDMPs. Patients can travel from state to state reporting false information without effective data sharing. Programs must continue to grow which is why the CDC has decided to help with funding so states can not only enhance their programs but improve the education of providers and patients. Over the next four years, the CDC is committing $20 million to 16 states – Arizona, California, Illinois, Kentucky, Nebraska, New Mexico, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, Tennessee, Utah, Vermont and Wisconsin. Due to recent events, Ohio is taking an additional step and investing $1.5 million a year to integrate the Ohio Automated Rx Reporting System (OARRS) into the process. OARRS allows healthcare providers to better treat patients and identify drug-seeking behaviors.
The PDMP process is effective in improving quality of care and reducing doctor shopping, diversion and prescription fraud. However, there are some concerns, such as patients’ access to prescriptions and prescribers’ reluctance to prescribe controlled substances due to legal retribution.7
Every program is plagued with opposing opinions, but prescription drug monitoring is likely to remain relevant for a long time. There will be a continued effort to push forward and address opioid addiction and abuse in the United States.
1 Michigan requires daily reporting of dispensing information and weekly for mail-in submission of data. 2Indiana will begin requiring the submission of data within 24 hours by January 1, 2016. 3Tennessee will begin requiring daily submission on January 1, 2016. 4Connecticut will go real time/24 hours reporting on July 1, 2016. It requires marijuana dispensaries to report marijuana dispensing to the PMP daily. 5Oregon goes to reporting within 72 hours on January 1, 2016. 6Wyoming goes to daily reporting on January 1, 2016.
1,5,6 “Briefing on PDMP Effectiveness.” PDMP Center of Excellence at Brandeis University. Sept. 2014. Web. 16 Nov. 2015. http://www.pdmpexcellence.org/sites/all/pdfs/Briefing%20on%20PDMP%20Effectiveness%203rd%20revision.pdf.
2 “Opioid Addiction Disease 2015 Facts & Figures.” American Society of Addiction Medicine. n.d. Web. 23 Nov. 2015. http://www.asam.org/docs/default-source/advocacy/opioid-addiction-disease-facts-figures.pdf.
3 Griggs, Christopher, et al. “Prescription Drug Monitoring Programs: Examining Limitations and Future Approaches.” National Center for Biotechnology Information, US National Library of Information. Jan. 2015. Web. 16 Nov. 2015. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4307729/.
4 “2015 Annual Review of Prescription Monitoring Programs.” National Alliance for Model State Drug Laws. Sept. 2015. Web. 16 Nov. 2015. http://www.namsdl.org/IssuesandEvents/2015%20Annual%20Review%20of%20Prescription%20Monitoring%20Programs.pdf.
7 Islam, M and McRae Ian. “An inevitable wave of prescription drug monitoring programs in the context of prescription opioids: pros, cons and tensions.” BioMed Central. Aug. 2014. Web. 17 Nov. 2015. http://www.biomedcentral.com/2050-6511/15/46/.