3 Thoughts on the New MassPAT Laws in Massachusetts

“Every breath you take, every move you make … I’ll be watching you.” So goes the popular 1983 hit song by the Police. But as of October 15, 2016, in Massachusetts, your doctor might just be singing this tune.

That’s when all registered practitioners in the state of Massachusetts were required to start checking the state’s online PMP (prescription monitoring program) known as MassPAT prior to prescribing a narcotic prescription. The law is intended to prevent patients from visiting multiple doctors and receiving overlapping prescriptions for opioids that might be abused or sold to others.

Specifically, the new law requires doctors in Massachusetts to check MassPAT (a) every time they write for a narcotic drug in Schedule II or III, and (b) the first time they prescribe a benzodiazepine for a patient.

In the midst of a national opioid overdose crisis, this seems like a reasonable and prudent piece of legislation. An estimated 1526 opioid overdose deaths occurred in 2015 in Massachusetts.² Although not all of those are related to opioid diversion or addiction, the practice of “doctor shopping” cannot be ignored, and prescribers now have the responsibility to check on their patients’ usage of controlled substances.

This law, combined with the new Massachusetts requirement for pharmacies to report narcotic dispensing on a daily basis (previously it was weekly) brings the state in line with some other states who have been requiring such checks for some time.³

So … will this help reduce the problem of doctor shopping and patients getting multiple prescriptions for narcotics from different prescribers?

I think that depends on a few things.

First, will the new law will actually be enforced? Let me be clear. It’s my impression as a Massachusetts pharmacist that the vast majority of narcotic prescribers in our state are prescribing with great care and caution already. As is usual in life, a few are creating more work for the rest. And they need to be dealt with. But the legislation itself doesn’t appear to specifically state how compliance with this law will be monitored. Will the state move to revoke the licenses of doctors who don’t appear to have checked MassPAT before prescribing? That remains to be seen.

Second, will doctors actually change their prescribing habits based upon what they find? Again, most are already prescribing conservatively. But for those who aren’t, will this change things? I do suspect this tool will put a useful resource into the hands of physicians in the emergency departments of our hospitals. Also, the first time that prescribers see a new patient, they’ll be able to screen the patient even before they see him or her. But for those few doctors who are knowingly and deliberately abusing the privilege of their profession, it’s hard to see how requiring them to check MassPAT will help.

Third, and maybe most importantly, the question remains to be seen whether or not doctor shopping and obtaining multiple opioid prescriptions for different prescribers and at different pharmacies is really a significant contributor to our addiction and opioid problem. The new law does nothing to deter the patient who sees one doctor and gets a large supply of monthly oxycodone, which they in turn sell or personally abuse. This law doesn’t stop a patient from convincing their doctor to increase their opioid dosages steadily over time to feed their addiction or diversion problem. And this law itself does nothing to identify patients who may be accessing opioids through illegal, nonpharmacy purchases.

Don’t get me wrong. This new MassPAT requirement is an important step. But this problem is too big for any one solution. Our nation and states are, therefore, taking a multifocused approach through various legislation and administrative efforts.

So maybe “every breath you take” is an exaggeration of the abilities of our MassPAT program. But doctors in Massachusetts can certainly say to their patients with more confidence than ever before, “I’ll be watching you.”

References

Department of Health and Human Services. Effective October 15, 2016 — New Requirements to Utilize the MassPAT. Mass.gov website. mass.gov/eohhs/gov/departments/dph/programs/hcq/drug-control/pmp/reporting-and-use.html. Accessed October 30, 2016.

Department of Public Health. Data brief: opioid-related overdose deaths among Massachusetts residents. Mass.gov website. mass.gov/eohhs/docs/dph/quality/drugcontrol/county-level-pmp/data-brief-overdose-deaths-may-2016.pdf. Accessed October 30, 2016.

Vestal C. States require opioid prescribers to check for “doctor shopping.” Stateline. May 9, 2016. The Pew Charitable Trust website. pewtrusts.org/en/research-and-analysis/blogs/stateline/2016/05/09/states-require-opioid-prescribers-to-check-for-doctor-shopping. Accessed October 30, 2016.