PDMPs Can Help Curb the Opioid Epidemic

In the past few years, the opioid epidemic has become a national crisis, and many steps have been taken in prescribing, monitoring, and restricting the use of opioid treatments. Each day, an average of 130 Americans die from opioid overdoses,¹ and more Americans die from an overdose than from any other type of preventable or unintentional death.² By 2017, the number of deaths from opioid overdoses resulted in a decline in overall life expectancy in the United States.²

To understand how the opioid epidemic arose, we must describe 3 distinct periods.¹ The first period began in the 1990s with the increase in prescription opioids, including hydrocodone, methadone, and oxycodone. The second wave started in 2010 and involved a rapid increase in deaths by heroin overdose. The third wave began in 2013, with an increase in overdose deaths from synthetic opioids, especially illegally manufactured fentanyl.¹

What is happening to stop this epidemic? States can use electronic data collection, real-time monitoring, and trend analysis to help identify and respond to this crisis. Prescription drug monitoring programs (PDMPs) or prescription monitoring programs (PMPs) are electronic databases that help prescribers and other providers by providing tools to address potential abuse or diversion. These state-run programs give real-time information to quickly identify possible drug-seeking behavior and inappropriate prescribing.

With the exception of Missouri, each state maintains a PDMP that is operated by a different group, depending on the location. These groups include consumer protection bodies, health departments, law enforcement, licensing boards, and substance abuse agencies.³ Missouri covers more than 90% of its population through city and county solutions; a statewide PDMP is not yet operational.

The Drug Enforcement Administration is not involved with state administration of a PDMP. Requirements for reviewing PDMP information vary in each state. Some states have no requirement for review before pharmacist verification and/or prescribing.⁴ The figure shows states that require both pharmacist and prescriber review, just prescriber review, and those with no mandatory review requirements.⁵

Because PDMPs offer such promising data and value, increasing access within a provider’s workflow has become an ongoing project for several electronic health records (EHR) and information technology initiatives. Challenges arise because of the variety of PDMPs and the different standards required for data collection. Several projects and studies were completed to identify provider access to PDMP data and how to improve it.⁶ These studies’ results showed that ease of use contributes to accessing PDMP data (ie, not having to log into a separate portal and search for patients). For example, if these data can be directly embedded into a patient’s chart within the EHR, a provider needs just 1 click to display a patient’s record, in addition to documentation of a PDMP review for states that require this.

Prescribers have also struggled with the lack of interstate data sharing and potential confidentiality issues as barriers to using a PDMP.⁷ The National Association of Boards of Pharmacy uses PMP InterConnect, which allows the transfer of data from PDMPs across state lines.⁸ All states participate in the interstate data sharing, while 40 states also use the PMP Gateway for clinical integration.⁹

Pharmacy technicians have an important role in the utilization of PMDPs. In most states, to access the PDMP, a tech must be approved as an authorized delegate or user prior to reviewing data. This is because many databases are accessible to only pharmacists and prescribers, for the purpose of treatment review for existing or potential patients. Once approved as a delegate, techs can assist pharmacists by reviewing PDMPs prior to dispensing controlled substances.

Here are troubling signs that techs should watch for in a PDMP:

• concurrent use of several long- and short-acting benzodiazepines and opioids;
• continuous increases in dosing, early refills, or a pharmacy not located near the physician;
• doctor shopping;
• prescriptions filled at multiple pharmacies or pharmacy shopping; and
• prescriptions written by multiple providers

From this information gathered by techs, pharmacists can enhance patient care by identifying interaction risks, initiating conversations regarding potential abuse or misuse, and referring patients to counseling or resources on substance use disorders.¹⁰ Although PDMPs alone will not stop the opioid epidemic, they do offer a huge benefit for pharmacists and prescribers to reduce potential diversion and prescription drug abuse.

Kristy Malacos, CPhT, is the pharmacy administrator and purchasing director at Magruder Hospital in Port Clinton, Ohio.

REFERENCES

• Understanding the epidemic. CDC website. cdc.gov/drugoverdose/epidemic/index. html. Updated December 19, 2018. Accessed October 12, 2019.
• Kapil R. 5 surprising facts about opioid use. National Council for Behavioral Health website. mentalhealthfirstaid.org/2019/03/5-surprising-facts-about-opioid-use/. March 20, 2019. Published Accessed October 12, 2019.
• Weber L. Why Missouri’s the last holdout on a statewide Rx monitoring program. Kaiser Health News website. khn.org/news/why-missouris-the-last- holdout-on-a-statewide-rx-monitoring-program/. Published May 20, 2019. Accessed October 12, 2019.
• Mandatory PMDP use. PDMP Assist website. www.pdmpassist.org/pdf/ Mandatory_Query_Conditions_20180801.pdf. Accessed October 13, 2019.
• PDMP mandatory query by prescribers and dispensers. PMDP Assist web- site. www.pdmpassist.org/pdf/Mandatory_Query.pdf. Updated December 13, 2016. Accessed October 13, 2019.
• Connecting for impact: linking potential prescription drug monitoring pro- grams (PDMPs) to patient care using health IT. HealthIT.gov website. healthit. gov/topic/health-it-health-care-settings/connecting-impact-linking-potential-prescrip- tion-drug-0. Updated May 21, 2019. Accessed October 13, 2019.
• National drug control strategy. National Alliance for Model State Drug Laws web- site. namsdl.org/wp-content/uploads/NDCS.pdf. Published January 2019. Accessed October 13, 2019.
• NABP PMP Interconnect: the only national network of state-based PMPs. National Association of Boards of Pharmacy website. nabp.pharmacy/initiatives/pmp-intercon- nect/. Accessed October 13, 2019.
• Facilitating data sharing across state borders and into clinical workflows. PMP Interconnect website. pmpinterconnect.com/. Accessed October 13, 2019.
• Prescription drug monitoring programs: a guide for healthcare providers. Substance Abuse and Mental Health Services Administration website. store.samhsa. gov/system/files/sma16-4997.pdf. Published 2017. Accessed October 13, 2019.