Many local, state, and federal agencies have implemented different policies to address prescription drug abuse, including prescription drug monitoring programs (PDMP). “PDMPs are becoming increasingly popular because they provide clinicians with scheduled medication histories,” explains Christopher A. Griggs, MD, MPH. “When used appropriately, they can help identify patients who may be diverting medications or abusing them.”
Throughout the country, some states have passed laws mandating that providers use PDMPs in certain circumstances to combat the prescription drug epidemic, but their potential limitations may be overlooked. “While these programs are a valuable tool in concept, their effectiveness must still be proven,” Dr. Griggs says. “PDMPs should be used in addition to more comprehensive and evidence-based strategies in order to combat prescription drug abuse.”
PDMP databases generate data from pharmacies that are directly reported to the state when prescriptions are filled, but Dr. Griggs says each state has varying delays in how long it takes for the data to appear in the database. “There are also concerns about identifying patients who ‘doctor shop’ because there is no clear definition of what constitutes questionable patient behavior,” he says. “This can make it challenging for physicians to balance their duty to treat pain, meet patient expectations, and prevent misuse and diversion.”
In order for PDMPs to be effective, it is critical to recognize the amount of misuse and diversion that results from clinician prescribing. However, Dr. Griggs notes that PDMPs may be unable or ill-equipped to identify many important sources of diversion, such as chronic pain patients with one prescriber who divert their prescriptions.
Emergency physicians are essential to expanding the discussion on how to effectively prevent prescription drug abuse. For PDMPs to be successful, further improvements are needed to improve accuracy, accessibility, and interpretability of the data. “PDMPs need to overcome limitations in data sharing and enable providers to communicate more effectively with patients,” says Dr. Griggs. “It’s not enough to simply refuse to prescribe certain drugs to patients with concerning PDMP profiles. Instead, we must have candid conversations with patients so that we can direct them to more comprehensive resources for treatment.”
Dr. Griggs adds that ED clinicians are already overloaded with work, making it challenging to conduct PDMP reviews for all patients. “To increase the value of using PDMPs, we need easily accessible data and evidence to guide us on how to incorporate it into patient care,” he says. “More funding to integrate PDMP data into medical records is paramount. Ultimately, we need to better establish how PDMPs should be used during patient encounters and to identify the values in PDMP reports that should trigger an intervention.”
Readings & Resources (click to view)
Griggs CA, Weiner SG, Feldman JA. Prescription drug monitoring programs: examining limitations and future approaches. West J Emerg Med. 2015;16:67-70. Available at: http://escholarship.org/uc/item/2147k2t1#page-1.
Weiner SG, Griggs CA, Mitchell PM, et al. Clinician impression versus prescription drug monitoring program criteria in the assessment of drug-seeking behavior in the emergency department. Ann Emerg Med. 2013;62:281-289.
Li G, Brady JE, Lang B, et al. Prescription drug monitoring and drug overdose mortality. Inj Epidemiol. 2014;1:1-9.
Paulozzi LJ, Kilbourne EM, Desai HA. Prescription drug monitoring programs and death rates from drug overdose. Pain Med. 2011;12:747-754.
Brady JE, Wunsch H, DiMaggio C, et al. Prescription drug monitoring and dispensing of prescription opioids. Public Health Rep. 2014;129:139-147.