The Value of Prescription Monitoring Programs

A recent study from Vanderbilt University in Nashville proclaimed that prescription drug monitoring programs (PDMPs) can reduce prescription drug—related overdose deaths. According to the study results published in the June issue of Health Affairs, “If Missouri adopted its own PDMP, and every state enhanced its existing program, some 600 overdose deaths would be avoided annually.”¹

Missouri is referred to because, as of this writing, it is the only state without a PDMP. Establishment of a PDMP is being debated in the Missouri legislature, however, as other states have enjoyed incredibly successful PDMPs for years. Missouri is not only a haven for in-state seekers of illegitimate refills, but the state also attracts offenders from bordering states! The prescribers and dispensers with whom I have spoken over the past few years are fed up with the problem and the legislature’s lack of response to it.

When some PDMPs first started, it was difficult to get prescribers to use them, even though there is no cost to prescribers. When Ohio’s PDMP began, for example, several years passed with only a 25% participation rate. This rate has been improved through various methods initiated by the Ohio Pharmacy Board, which hosts and operates the daily operations of its PDMP.

The speed of access to PDMPs and the closer they get to real-time reporting have made a difference in the number of users and the ability to effectively use the data to help prevent prescription drug abuse. Weeks of backlog have turned into a day or two, with all PDMPs working toward real-time reporting— which is attainable, but adds to the expense.

The quality of PDMPs varies from state to state, with some states still refusing to allow access to law enforcement. Prescribers, dispensers, and law enforcement need to have equally fast access to PDMP data to put together quality cases that, in some instances, can save lives. When states require search warrants or even subpoenas to access the data, this drastically slows down the process of tracking down drug seekers or criminal prescribers and dispensers.

In my part of the country, where Ohio, Kentucky, and Indiana meet, the borders can be easily crossed in a few minutes to complicate criminal case investigations. Fortunately, cooperation among the 3 states, and the quality of their PDMPs, complement the work of the prescribers, the dispensers, and law enforcement.

PDMPs are of tremendous use when criminal prescribers are suspected and data are needed to put together a case for prosecution. Before these data were available, investigators would have to go from pharmacy to pharmacy to collect the prescription data necessary to put an end to a pill mill.

Whenever PDMPs are mentioned, a national PDMP is usually touted. I will go on record saying that PDMPs would not survive a federal program run by federal bureaucrats who are trying to keep track of an enormous amount of information that drastically increases the chance of human error. States work hard to keep their PDMPs functioning as well as possible while protecting the integrity of the data. This job is anything but easy, and each state is vigilant in ensuring that an incorrect profile is not released because of human error. Multiply that by 50 states, and tell me that a national PDMP would not be more prone to errors that would lead to lawsuits and, potentially, the end of the program.

Besides, doctor shoppers very rarely seek prescribers in states that do not border their home state. Therefore, as long as states can access the PDMP data of bordering states, there will be access to the vast majority of the necessary data.

The bottom line is that PDMPs are extraordinarily valuable to health professionals, law enforcement, and regulators, and are ultimately valuable to the general public for reducing overdose deaths and addressing addiction issues earlier.

Cmdr Burke is a 40-year veteran of law enforcement and the past president of the National Association of Drug Diversion Investigators. He can be reached by e-mail at burke@rxdiversion.com or via the website www.rxdiversion.com.

Reference

• Larner L. Prescription drug monitoring programs help reduce opioid-related death rates. Health Affairs website. healthaffairs.org/ blog/2016/06/22/prescription-drug-monitoring-programs-help-reduce- opioid-related-death-rates. Published June 22, 2016. Accessed July 7, 2016.