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Prescription drug monitoring programs (PDMPs) are important tools in curbing the opioid crisis and reducing the need for addiction treatment. These are state-run databases that provide pharmacists, clinicians and members of state law enforcement agencies with information about a patient’s prescription history and offer insight into whether they are a risk for prescription drug misuse.
Illinois and New York were among the first states to adopt a PDMP, and today there are 49 states with an operating PDMP. Each state’s best practices take into consideration their individual health priorities, cost/benefit ratios, public support, resources and infrastructure.
The Centers for Disease Control and Prevention (CDC) reported that there were more than 22,000 prescription painkiller overdoses deaths each year.
The benefits of a PDMP include expanded access to controlled substances for medical use, a decreased number of opioid prescriptions, reductions in doctor-shopping, prevention of drug diversion and overdose, more information about prescription drug abuse and addiction, awareness of trends and public health initiatives, and facilitating treatment for substance use disorder.
In 2012, both Kentucky and Oklahoma saw their first declines in opioid overdose deaths for the first time in 10 years after implementing a PDMP. Florida, Washington and New York have also reported reductions in overdose deaths, emergency room visits and treatment admissions. States with active PDMPs saw decreases in opioid prescriptions and shipments and were associated with a slower growth in painkiller availability and instances of doctor-shopping.
PDMPs also seemed to improve clinical decision-making. A study published in the journal Addiction last November revealed that 70 percent of surveyed Maryland physicians decreased their rate of opioid prescriptions after accessing the program’s data and 74 percent found the data to be “very useful.”
A case study of Ohio, published this year in the Journal of the American Pharmacists Association, discussed how pharmacists could enhance the effectiveness of their state’s PDMP. As the state with the fifth-highest rate of overdose deaths, the findings showed the monitoring program continued to be the best way for pharmacists to identify those likely to develop an addiction to opioids.
Missouri is the only state that doesn’t have a PDMP in place, but recently the state Senate approved a proposal after multiple legislative attempts over the years due to privacy worries and possible data breaches. State Senator Rob Schaaf has consistently blocked and threatened to filibuster any bills entering the chamber that attempt to establish a program.
Health care providers across the country have raised concerns of their own.
A clinician in Washington, Dr. Gregory Terman, laments the time-consuming process of checking medication histories for each patient before prescribing opioids. “If the law prohibits prescribing opioids until a clinician checks the database, and access is long and laborious, it is not rocket science to hypothesize that opioid prescribing will decrease,” he stated.
The American Civil Liberties Union (ACLU) also objected to the way databases can be accessed. Since PDMPs are fully state-run, the Drug Enforcement Administration (DEA) has no involvement, however, the DEA asserted that a federal statute gives them access to the records without a warrant. Because of this, the ACLU in Oregon opposed the creation of a PDMP but helped the state add privacy safeguards to its program and joined a lawsuit against the DEA. In 2014, a federal judge ruled that the DEA must obtain a warrant to access the database.