The expansion of prescription drug monitoring programs (PDMPs) across state lines is an important tool in preventing individuals from “doctor shopping” for multiple opioid prescriptions, and could have a huge effect on the battle against opioid misuse, abuse and diversion, according to pain medicine experts and state officials.
“Right now, we are in the midst of a public health crisis, a prescription drug problem. One of the biggest issues we have is that pain is so difficult to treat, and we have so few options, that there are patients who require controlled substances to manage their pain,” said Jeffrey A. Gudin, MD, director of the Pain Management Center at Englewood Hospital and Medical Center. This is compounded by the fact that U.S. opioid-related overdose deaths reached all-time highs in 2014, many of them a result of painkiller diversion into the hands of those who abused and misused them.
The Advent of PDMPs
Prescription drug monitoring programs, which have come into being in roughly the last decade, are computerized databases that clinicians can query each time a patient comes to their office or pharmacy, or anytime there is a question about a patient’s medications. According to Dr. Gudin, PDMPs are one of three key ways to prevent diversion of controlled substances, along with patient questionnaires, to assess risk in individual patients and drug testing using urine or saliva drug monitoring.
“[Prescription drug monitoring] gives us a comprehensive list of which patient filled the prescription, where the patient filled the prescription, what drug it was for, what dose it was for, how many pills they got, which pharmacy filled it and which doctor wrote the prescription,” said Dr. Gudin. “And just between those three things—questionnaires, drug screening and PDMPs—we have revolutionized the way we assess our patients for the risk of drug abuse.”
Currently, 49 states and the District of Columbia have legislation allowing for the development of PDMPs. (Missouri does not have PDMP legislation, and Washington, D.C.’s PDMP is not functional.) Differences in PDMPs exist from state to state, from varying levels of physician participation, to frequency of data collection, to what drug schedules are monitored (from Schedule II to V; some also include other “drugs of concern”). What state entity runs the PDMP also varies, including state departments of health, pharmacy boards, law enforcement and professional licensing boards. How the PDMPs are paid for ranges as well: from state-funded, to controlled substance prescribing license registration fees, to federal grants.
For many years, according to Dr. Gudin, PDMPs were limited to one state, with little to no sharing of information occurring across borders.
“However, in the last few years, technology has allowed us to check other states’ PDMPs with just one query of the database,” he said. “That’s really what’s needed, because there are states across the country that are bordered by three or four other states, so patients can go from one state, where they have prescription monitoring, to another one where perhaps they don’t—or don’t share the data—and easily fill a prescription. So, having this cross talk between PDMPs will be critical to improving the success of safe prescribing.”
New Jersey and the Interstate Hub
Currently, there are four regional PDMPs in the United States. In states such as New Jersey, efforts are well underway to expand their PDMP region, making it that much more difficult for individuals looking to obtain multiple opioid prescriptions across different states. Before the creation of regionalized PDMPs, a primary care physician in New Jersey might have been caught unaware that a patient was trying to obtain painkillers from a pain medicine specialist in New York City, given that the state databases were not connected.
To remedy the situation, New Jersey has worked since it developed its own PDMP in 2011 to create a connected database that could be accessed when needed by physicians and pharmacists in other states. Gov. Chris Christie (R) appeared at a press conference on April 6 at Englewood Hospital and Medical Center to announce another link in the “Interstate Hub” PDMP chain: Eight days earlier, New York joined New Jersey in sharing PDMP information, along with Connecticut, Delaware, Minnesota, Rhode Island, South Carolina and Virginia.
When it comes to physician participation in the PDMP, New Jersey has been a model for other states. According to Mr. Christie, increasing physician involvement in the database has been a goal for several years, starting when the participation percentage languished in the teens. Now with 96% physician participation, and almost 59 million prescription drug records contained in its PDMP, state officials believe they are making a real difference against the ongoing opioid epidemic.
“It is an innovative partnership between New Jersey’s attorney general’s office and state prescribers, and one of our best tools in the fight against diversion of prescription drugs,” said Mr. Christie. “And now, prescribers in New Jersey are successfully making use of our ability to view cross-border prescriptions.”
Mr. Christie noted that in the first nine months of 2015, 123,000 prescriber data requests were shared between New Jersey, Connecticut and Delaware alone. In the fourth quarter of 2015, after Minnesota, Rhode Island, South Carolina and Virginia joined the Interstate Hub, 63,000 requests were made. In the eight days after New York joined, the group had already seen 16,000 individual pieces of information shared. Mr. Christie called the new collaboration with New York “the single most important expansion we’ve had so far.