Opioids: Can We Unlock the Potential of Prescription Drug Monitoring Programs?
A recent report from the Substance Abuse and Mental Health Services Administration indicates that in 2015 more adults used prescription painkillers than cigarettes, cigars, and smokeless tobacco combined. Politicians, government agencies, and policymakers have touted prescription drug monitoring programs as a way to curb the over-prescription and side effects of opioids.
While prescription drug monitoring programs (PDMPs) are a useful tool for healthcare providers, they are no magic pill for the opioid epidemic. In fact, PDMPs have structural and operations limitations that hinder their potential. Lawmakers and healthcare leaders should move fast to address these limitations.
What are PDMPs? They are state-based databases that monitor controlled substances dispensed in the state. They do that by storing information about the dose and quantity of the dispensed drug — the date, the prescriber, and the patient — that is available to pharmacists, providers, and law enforcement. PDMPs have the potential to educate providers about patients who have multiple providers, use multiple pharmacies, pay cash, are on high doses, or on dangerous medication combinations. This is particularly important because both higher doses and combinations with other sedatives substantially increase the risk of opioids.
PDMP data can be helpful to providers weighing the risks and benefits of including opioids in the treatment regimens of patients experiencing pain. Providers should check PDMPs regularly when treating patients with acute or chronic pain — at least every three months for patients on chronic opioids, according to recently released CDC opioid guidelines.
In 2002 only 17 states had PDMPs. Now 49 states have them. Being relatively new, their efficacy has not yet been widely evaluated in peer-reviewed studies. One major study published in the Annals of Emergency Medicine evaluated the impact of PDMP data on emergency room providers treating adult patients with pain. The authors found that the presentation of PDMP data changed the provider’s medical decision in 41 percent of patients. 61 percent of the time the PDMP data decreased the amount of opioids prescribed, and 39 percent of the time the PDMP led to increased prescription of opioids. Research in Pain Medicine looked at PDMPs and drug overdose mortality from 1999 to 2005. The authors concluded that overdose rates and opioid-contributed overdose rates rose with or without PDMPs and that there were no statistically significant differences between states with or without PDMPs.
More research is needed on the impact of PDMPs on opioid prescribing patterns and side effects and to overcome their limitations in combatting the opioid epidemic.
What limitations? Like all data, PDMP data is subject to manual error. Furthermore, the programs are state-based meaning, they inform providers about controlled substances filled in the provider’s state but not necessarily about controlled substances filled in other states. This is especially problematic in state-packed regions such as the North East. PDMPs also do not include controlled substances filled in federal facilities such as those of the DOD and VA. So while PDMP data can be useful to physicians weighing the risks and benefits of opioids, it’s important to keep in mind that these data are limited.
There are operational limitations as well. More and more hospitals and physicians are using electronic health records, but PDMP data is not integrated into these records. Thus physicians — many of whom already face significant time pressure — must take the time to actively seek out and find the data, themselves, using the PDMP systems, which can be cumbersome, clunky, and difficult to navigate. Some states allow physicians to delegate access to PDMP data; others states do not.
Policymakers and healthcare leaders should work to remove these limitations. PDMP data should include all of a patient’s filled prescriptions, for instance, not just those prescriptions filled in the relevant state on non-federal land. Policymakers must also recognize the time constraints faced by healthcare providers. Every effort should be made to make the data readily accessible and easy to comprehend. Providers, meanwhile, would benefit from additional education and training on how to interpret and respond to PDMP data.
Lawmakers must be realistic about the efficacy of PDMPs, while seizing this opportunity to help the provider community work to treat chronic pain safely and to mitigate the risk of opioids.