Prescription drug monitoring programs offer tremendous potential – to either effectively curb abuse or to overburden prescribing doctors, making patients struggle to get the pain relief they legitimately need. The challenge lies in achieving the former without effecting the latter. To strengthen these programs, policymakers must design PDMPs with user-friendly, efficient methods for minimizing abuse.
For example, programs should incorporate incentive-based measures for complying physicians. Fining or revoking the licenses of physicians who do not consult the PDMP database can inadvertently – and unfairly – punish physicians who are older, less tech savvy or practicing in rural areas with limited technology. Policymakers could also improve PDMPs’ user friendliness by streamlining aspects of the program. Otherwise, physicians with limited staff may determine the requirements to be too cumbersome, leading some to simply stop prescribing the pain medications their patients need.
Moreover, PDMPs should assume a more coordinated approach. State-run programs address abuse with varied success in their own states, but interstate cooperation could improve PDMPs’ effectiveness. For physicians [like me] who practice medicine near a state border, consulting the PDMP database won’t necessarily prevent our patients from accessing unadvisable quantities or combinations of medication. Patients can, and too often do, simply cross state lines and obtain a prescription from another state’s physician. A more sophisticated, interconnected system could eliminate this opportunity for abuse.
The broadest area for improvement, however, is in ensuring that patients with legitimate need don’t get shut out from the access they deserve. For PDMPs to curb abuse effectively, policymakers must constantly refine program mechanisms to hone their precise application to pain pill abusers. Only with a laser-sharp focus on abuse can policymakers prevent PDMPs from inadvertently complicating access for patients in legitimate pain.
Srinivas Nalamachu is clinical assistant professor in the Department of Rehabilitation Medicine at Kansas University Medical Center and clinical assistant professor in the Department of Internal Medicine at Kansas City University of Medicine and Biosciences. A member of the Alliance for Patient Access, he has written more than 100 publications/abstracts and has lectured on chronic pain, neuropathy and cancer pain.
The American Medical Association (AMA) believes that modernized, interoperable Prescription Drug Monitoring Programs (PDMPs) have the potential to be a powerful clinical tool to help prevent prescription drug abuse, diversion, overdose and death. As states continue to consider how to best deploy PDMPs, the AMA has specific recommendations as part of our comprehensive efforts to help prevent prescription drug abuse and diversion.
First, legislative efforts must focus on how to use PDMPs most effectively rather than on how often they are used. This includes ensuring that PDMPs are up-to-date, able to work with other PDMP systems and available at the point of care as part of a physician’s workflow. Under a pilot project, the state of Ohio placed PDMPs in its emergency departments and found that 41 percent of prescribers equipped with PDMP data actually altered their prescribing habits when the data showed some patients were receiving multiple simultaneous prescriptions for controlled substances. Of those prescribing providers with PDMP data, 61 percent prescribed no opiates or fewer than they had originally planned. This indicates that PDMP data can help inform sound clinical decision-making and emphasize effective treatment and prevention strategies to ensure prescriptions are medically necessary, thereby reducing abuse and illicit use of controlled substances.
Second, in order to be effective, PDMPs must be adequately funded, maintained and modernized to ensure their long-term ability to help combat prescription drug abuse, misuse and diversion. The Congressional Research Service estimates that PDMP costs may vary widely, with start-up costs ranging from $450,000 to over $1.5 million and annual operating costs ranging from $125,000 to nearly $1 million. State leadership is sorely needed to ensure PDMPs have the support they need, and this includes making sure every state has a PDMP that is truly interoperable with every other state.
Third, the AMA encourages policymakers and public health officials to rely on public health strategies when considering how a PDMP can most effectively support the reduction of prescription drug abuse, diversion, overdose and death. Physicians welcome the opportunity to use best practices, regularly rely on evidence-based approaches to treatment and have been trained in how to analyze scientific information as part of their medical practice. That is why the AMA supports modernized PDMPs so that physicians will be encouraged to adopt a reliable decision-making tool as part of their practice.
Finally, the AMA strongly encourages states to work collaboratively among all stakeholders, including state and federal agencies, to identify who from the health care chain should be involved in implementing PDMPs. This is the best approach to ensure that Prescription Drug Monitoring Programs are effective in combating prescription drug abuse and diversion – and preventing misuse, overdose and death. The AMA continues to welcome opportunities to be a part of these collaborative efforts to help stop this growing epidemic.
Ardis Dee Hoven, MD, an internal medicine and infectious disease specialist in Lexington, Ky., became the 168th president of the American Medical Association in June 2013. Dr. Hoven has been a member of the AMA Board of Trustees (BOT) since 2005, serving as its secretary for 2008–2009, chair for 2010–2011, and immediate past chair for 2011–2012.
Prior to her election to the AMA-BOT, Dr. Hoven served as a member and chair of the AMA Council on Medical Service. She was a member of the Utilization Review and Accreditation Commission for six years and served on its executive committee. Additional activities have included service on the AMA Foundation board of directors, the Group Practice Advisory Council of the AMA and an appointment to the Practicing Physicians Advisory Commission. Currently Dr. Hoven serves as the AMA-BOT representative on the Board of Directors of the National Quality Forum, and the Quality Alliance Steering Committee. She has recently concluded service on the COLA board, the National Advisory Council for Healthcare Research and Quality, and the AMA-convened Physician Consortium for Performance Improvement®.
Dr. Hoven’s involvement at the state level has been extensive. She was president of the Kentucky Medical Association from 1993 to 1994 and served as a delegate to the AMA from Kentucky prior to her election to the AMA-BOT. She has also been actively involved in medical staff issues at her local hospital and has held a variety of positions, including president of the medical staff, member of the board of directors and president of the hospital foundation board.
Born in Cincinnati, Dr. Hoven received her undergraduate degree in microbiology and then her medical degree from the University of Kentucky, Lexington. She completed her internal medicine and infectious disease training at the University of North Carolina, Chapel Hill.
Board-certified in internal medicine and infectious disease, Dr. Hoven is a fellow of the American College of Physicians and the Infectious Disease Society of America. She has been the recipient of many awards, including the University of Kentucky College of Medicine Distinguished Alumnus Award and the Kentucky Medical Association Distinguished Service Award. In 2013, Dr. Hoven was named one of Modern Healthcare Magazine’s Top 25 Women in Healthcare.
Dr. Hoven is married to Ron Sanders, PhD, an economist and college professor. They share a mutual enjoyment of two grandchildren, sports, travel and philanthropic activities.
Prescription Drug Monitoring Programs (PDMP) are effective tools for collecting and analyzing prescription data, but across the country they remain underused. Clinicians do not routinely check PDMP data to identify patients who are abusing or diverting prescription drugs so they can make appropriate decisions for treating individual patients. According to a report prepared for the Office of the National Coordinator for Health Information Technology in 2012, only 5 percent to 39 percent of providers use PDMP data, depending on the state.
There are number of reasons why PDMPs are not being used in the most effective manner. Providers, such as doctors, dentists and pharmacists, may not be aware of their benefits or even registered to use them. Data within PDMPs may not be current or real-time, limiting their effectiveness. Restrictions on the use of data or metadata contained within PDMPs limit their usefulness in identifying trends or areas of concern within individual states and regions. Inputting data into and accessing PMDP databases may not easily fit with providers’ clinical workflows. Finally, privacy concerns may limit the extent to which PDMP data can be used for law enforcement, public health and research purposes.
There are, however, efforts in states to improve the use of PDMPs. To improve clinical workflow and make it easier for providers to access PDMP data, Arkansas is working to integrate its PDMP with the state’s electronic health records system. Alabama and Colorado are exploring the same option. Virginia is working to integrate its PDMP with Connect Virginia, the commonwealth’s health information exchange, which electronically connects physicians and providers for sharing patient health information. Alabama and Oregon passed legislation that allows physicians to delegate PDMP access to authorized employees. Oregon’s law authorizes physicians in California, Idaho and Washington who treat Oregonians to access Oregon’s PDMP, and it allows public health authorities to use PDMP data without patient identification for research and other purposes. Alabama, Arkansas, Colorado, Kentucky, New Mexico, Virginia and 17 other states use three data sharing hubs to share data across state lines with each other and with authorized users; all three hubs are interoperable and will exchange data upon completion of memorandums of understanding.
Kentucky created a system that allows prescribers to run PDMP reports on their own practice to monitor for diversion of controlled substances. To increase physician registration with the state’s PDMP, Virginia’s Department of Health Professions will automate PDMP registration by tying to it to the license renewal process for providers.
PDMPs are an important tool in the effort to reduce prescription drug abuse. However, they are only one component of a comprehensive approach. Any effective strategy also will focus on changing prescriber behavior, educating the public, promoting proper disposal, providing adequate treatment and ensuring appropriate enforcement. Only through such comprehensive approaches by states will the nation be able to effectively combat this epidemic.
Thomas oversees the NGA Center's work on justice and public safety policy issues. In this role he currently directs the NGA Prisoner Reentry Policy Academy, the National Cyber and Electronic Crime Strategic Policy Project, the Improving Forensic DNA Policy Project, and the Public Safety Performance Project. He is also the co-lead on the NGA State Leadership in Criminal Justice Information Technology Integration Project, a project designed to help improve how states share criminal justice information within their criminal justice systems. Thomas also provides targeted technical assistance to governors' criminal justice policy advisors on a range of criminal justice policy issues, including forensic DNA, sex offenders, methamphetamine production, prisoner reentry, and sentencing reform.
The Partnership at Drugfree.org knows that PDMPs are an important component in addressing the medicine abuse epidemic. We support the position of the National Association of Boards of Pharmacy on the need for PDMPs in all 50 states and DC, with those programs interconnected to be able to share data, thereby providing a more effective means of combating drug diversion and drug abuse nationwide.
While PDMPs are either operational or proposed in nearly every state, there is more work to be done to grow strengthen this fundamental network. Expanding upon the current PDMP system could dramatically reduce the abuse and misuse of medicine in this country. Every state needs to do more to ensure that these programs are adequately funded and utilized, and medical groups have to do more to encourage prescribers to use them.
Through The Medicine Abuse Project, The Partnership aims to prevent half a million teens from abusing medicine by the year 2017. Health care providers are in a powerful position to prevent this growing and devastating problem, and establishing and utilizing large-scale, well-run PDMPs will be a vital step toward addressing the critical issue of medicine abuse.
The Partnership at Drugfree.org works closely with sponsors and supporters, corporate partners, media partners and alliances to develop public education communication campaigns that accomplish our partners’ strategic objectives while enhancing our programs to help people live healthy, drug-free lives.
Diversion of prescription drugs is a significant abuse problem, and state prescription drug monitoring programs (PDMP’s) have been created to be an efficient, cost effective tool for investigating and preventing drug diversion. A PDMP uses a centralized database in order to collect and review prescriptions on controlled substances. The intended effect is to share valuable information among providers and pharmacists as well as limit drug overdoses and curtail doctor shopping and prescriber overuse.
While PDMP’s offer tremendous value, the U.S. Pain Foundation understands the challenges and struggles of those suffering with pain and discomfort and support PDMP’s which ensure those who need valuable medicines can continue to receive them in a seamless fashion.
To strengthen these programs, U.S. Pain Foundation supports commonsense sharing of information while avoiding stigmatization of patients who truly need valuable medications. By collaborating across all-sectors, including government, the medical community, and law enforcement — we can work towards educating the public on the value of PDMP’s and delivering pain-relieving medicines to those who truly need them.
U.S. Pain Foundation is a 501 (c)3 non-profit organization dedicated to serving those who live with pain conditions and their care providers. Founded in 2006 by a fellow person with pain, it is the mission of the organization to connect, inform, empower and advocate for the pain community. U.S. Pain is here to help those who live with pain and their care providers find resources and inspiration.