Many states have turned to prescription drug monitoring programs (PMPs) as a way to battle the abuse of opioid painkillers and other federally scheduled medicines. PMPs require doctors and pharmacists to report to a state registry the names of patients receiving the drugs. The registries also allow physicians, pharmacists and, in some cases, law enforcement to search through an online database to see if a patient is “doctor shopping” or already has a prescription.
Forty two states currently have PMPs, another six have enacted legislation to develop them, and federal agencies like the Food and Drug Administration and the Centers for Disease Control and Prevention have called for broadening such efforts.
But a new study from the American College of Medical Toxicology has found that many PMPs are not “user friendly” and often have rules that frustrate clinicians and prevent optimal use. Clinician awareness about the tools is poor, and some states restrict physician access, opening the database only to law enforcement officials.
One major complaint is the amount of time required to use a drug monitoring program.
“Even if it takes only three minutes per patient, in a busy emergency department or office practice, having to do this multiple times daily amounts to a substantial time investment,” said Lewis Nelson, MD, a professor of Emergency Medicine at the New York University School of Medicine. Some of the time-consuming aspects identified by doctors included navigating to the correct website and recalling and resetting passwords. Doctors also found that when they gained access to a state run database, timely information for each patient was not always available.
A “perspective piece” published online in the New England Journal of Medicine outlines a plan for an ideal drug monitoring program that would enable doctors, dentists, pharmacists, and law enforcement officials to access real-time data on patients’ prescription drug histories. Nelson and co-author Jeanmarie Perrone, MD, of the Perelman School of Medicine at the University of Pennsylvania, say such programs would allow physicians to take better care of patients who have legitimate pain issues, help identify potential drug abusers, and cut the number of opioids in circulation for diversion or sale on the black market.
“As the number of deaths associated with prescription-drug use surpasses the number of fatalities from motor-vehicle crashes in many states, we can learn from the success of auto-safety innovations that have mitigated mortality despite increased automobile use over the past three decades,” the authors write. “We should initiate active safety measures to address the growing rates of illness and death associated with the pharmaceuticalization of the 21st century.” The authors note that federal and state crackdowns on the abuse of painkillers have impaired doctor-patient relationships in cases of genuine chronic pain. Some regulations require patients to undergo urine drug screens or sign “pain contracts” in which they must agree not to sell or give their drugs away.
Among their recommendations: standardization of the type of information submitted to the databases, the use of bar-coded prescriptions to more quickly log entries, and a robust online prescription system that eliminates paper — and some of the doctor shopping that occurs.
They authors also suggest that PMPs include tracking of drugs ranging from those with the most potential for addiction (such as oxycodone) to codeine cough suppressants and stimulant drugs that may be sold or diverted.
The authors cite several benefits to a more robust drug-monitoring program, including the potential to provide clinicians with an early warning that a patient may need drug counseling or treatment. They believe the programs could also help identify patients who are receiving multiple legitimate prescriptions from different prescribers and who may be at risk of drug interactions.
“Although updating an existing prescription-drug monitoring database to incorporate these ‘ideal’ goals would require additional support and money, the potential to protect the public health is substantial,” Perrone and Nelson wrote.
Use of prescription opioids in the U.S.has increased four-fold since the mid-1990s, when pharmaceutical companies began marketing them for moderate pain. The number of people misusing and becoming addicted to the drugs also shot up. Today, nearly three quarters of all fatal drug overdoses in the United States are due to prescription drugs - far outnumbering deaths from cocaine and heroin combined.