Prescription Drug Monitoring Programs

Prescription Drug Monitoring Programs (PDMPs)

Prescription Drug Monitoring Programs (PDMPs) are state-run electronic databases used to track the prescribing and dispensing of controlled prescription drugs to patients. They are designed to monitor this information for suspected abuse or diversion (i.e., channeling drugs into illegal use), and can give a prescriber or pharmacist critical information regarding a patient’s controlled substance prescription history. This information can help prescribers and pharmacists identify high-risk patients who would benefit from early interventions.

PDMPs continue to be among the most promising state-level interventions to improve painkiller prescribing, inform clinical practice, and protect patients at risk. Additional research is needed to evaluate PDMP practices and policies to identify best practices.

Prescription drug monitoring programs (PDMPs), which electronically track prescriptions of all controlled drugs, now operate in 49 states (except Missouri) and Washington, DC (http://nyti.ms/1u8aKxQ). PDMPs can identify possible nonmedical use and diversion. Physicians can connect to them as part of prescribing while pharmacists can check them before dispensing.

Use of state prescription drug monitoring programs gives healthcare providers information to improve patient safety and protect patients. At the same time, they preserve patient access to safe and effective pain treatment.

Stakeholders:

American Medical Association:

Prescription drug monitoring programs need to be reliable and real-time. The AMA supports reliable, real-time information for prescription drug monitoring programs (PDMP) that are integrated into a physician’s daily workflow. PDMPs must be designed so that up-to-date information is immediately available when clinicians query the database and are considering a decision to prescribe a controlled substance. The PDMP must also be designed to ensure connectivity with other PDMP databases to ensure access across state lines and to all patient populations, including those within the Veterans Administration health system. Although the AMA continues to support National All Schedules Prescription Electronic Reporting Act of 2005 (NASPER), it has not been fully appropriated and needs to be reauthorized to support modernization of state-based PDMPs, including ensuring interstate interoperability.

Objective:

To target and minimize “Doctor and pharmacy shopping”

Best Practice:

A system for real-time monitoring of the prescription of opioids, such systems are already used in a number of countries. These systems help ensure that patients are not receiving opioid prescriptions from multiple doctors and allow law enforcement officials to track prescribing and dispensing patterns.

Progress Report:

A preliminary analysis of mandated PDMP use in Kentucky, Tennessee, and New York showed fewer episodes of patients seeking prescription opioids from multiple providers (http://bit.ly/1IP9kJP). Nonetheless, many PDMPs still need substantial improvements to reach the ideal in which they are easy to use, offer standardized content, update information in real time, and demonstrate interstate accessibility. Also, a new national initiative pairs law enforcement with public health officials to better trace and monitor trafficking of heroin, which in some states is now often laced with fentanyl, a powerful synthetic opioid.

Fully funding and modernizing PDMPs The AMA strongly encourages physicians and other prescribers to register for and use PDMPs. PDMPs have the potential to serve as a helpful clinical tool in the fight against prescription drug misuse. The AMA applauds the committee for taking up H.R. 1725, the “National All Schedules Prescription Electronic Reporting Reauthorization Act (NASPER),” and seeing it passed by the House of Representatives earlier this year. The reauthorization of NASPER and full appropriations are urgently needed to ensure that physicians across the country have patient-specific information through PDMPs at the point-of-care and to incentivize further implementation of best practices and information sharing between states. Fully funded and modernized PDMPs that contain relevant clinical information and are available at the point of care have been shown to be an effective tool to help physicians and other providers make appropriate prescribing decisions and ensure that patients with legitimate pain management needs continue to have access to medically necessary care.

Take Action:

Learn about the status of your state's effort to implement Prescription drug monitoring programs (PDMPs)

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Recommandations:

Prescription Drug Monitoring Programs. (PDMPs)

Mandate prescriber PDMP use.
Proactively use PDMP data for enforcement and education purposes.
Authorize third-party payers to access PDMP data with proper protections.
Empower licensing boards for health professions and law enforcement to investigate high-risk prescribers and dispensers.