Prescription monitoring program

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In the United States, prescription monitoring programs (PMPs) or prescription drug monitoring programs (PDMPs) are state-run programs which collect and distribute data about the prescription and dispensation of federally controlled substances and, as the individual states deem appropriate, other potentially addictive or abusable prescription drugs. PMPs help to prevent adverse drug-related events through opioid overdoses, drug diversion, and substance abuse by decreasing the amount and/or frequency of opioid prescribing.[1]

Most US health care workers support PMPs, which intend to assist physicians, physician assistants, nurse practitioners, dentists and other prescribers, the pharmacists, chemists and support staff of dispensing establishments, as well as law-enforcement agencies. The collaboration supports the legitimate medical use of controlled substances while limiting their abuse and diversion. Pharmacies dispensing controlled substances and prescribers are typically required to register with their respective state PMPs and (for pharmacies and providers who dispense controlled substances from their offices) to report the dispensation of such prescriptions to an electronic online database. Although forty-nine states have implemented PDMPs, little is known about these programs and their overall effectiveness. [2]

Definition[edit]

In the United States, prescription monitoring programs (PMPs) or prescription drug monitoring programs (PDMPs) are state-run programs which collect and distribute data about the prescription and dispensation of federally controlled substances and, as the individual states deem appropriate, other potentially addictive or abusable prescription drugs. PMPs help to prevent adverse drug events through opioid overdoses, drug diversion, and substance abuse by decreasing the amount and/or frequency of opioid prescribing.[3] A 2017 study found that "US states that have more robust prescription drug monitoring programs have fewer prescription opioid overdose deaths than states with weaker PMPs."[4]

History[edit]

Legislation and initiatives cannot be uniform throughout the nation. In New York designed a program called the Naloxone Co-payment Assistance Program, or N-CAP, which can help cover out-of-pocket payments when patients are picking up naloxone.[5] On a nationwide level, President Donald Trump’s administration has secured six billion dollars to stop opioid abuse. More specifically, there have also been efforts to strengthen criminal penalties for dealing and trafficking opioids.[6]

NaloxoneKit

Prescription drug monitoring programs, or PDMP’s, are an example of one initiative in place to alleviate effects of the opioid crisis. The programs are designed to restrict prescription drug abuse by limiting doctor shopping, diverting controlled substances, and improving decision making.[7]

PDMP’s have been implemented in state legislations since 1939 in California, a time before researchers were aware of the highly addictive properties of opioids.[8] Since 2014, 49 states and one US territory have enacted PDMP legislation. Of the 49, 48 have utilized the programs.[9]

Missouri is the only state within the United States that doesn’t have a PDMP.[10] One reason is because their republican senator, Rob Schaaf - who is also a physician, ceased any legislation that initiated drug monitoring programs. Moreover, he has introduced his own proposal which is considered medically inept as it doesn’t require physicians to view a patient’s narcotic history. Rather, it forces doctors to send the names of patients they are considering prescribing painkillers to the health department. This would put the decision out of the doctors hands, for better or worse. On the opposition, Missouri Representative Holly Rehder and Senator Dave Schatz have proposed a more common version of the monitoring programs, one that is similar to the rest of the United States. However, both proposals have not been able to be passed through at a cost to the Missouri people.[11]

Although prescription drug monitoring programs are not new to state legislation, they are constantly being updated for the current healthcare climate. Currently, a major goal is to streamline provider access and improve provider’s understanding of PDMP reports. This is being done by integrating PDMP reports into health information technologies (HITs) such as health information exchanges (HIE), electronic health record (EHR) systems, and/ or pharmacy dispensing software (PDS) systems.[12]

A specific program that has been implemented nine states is called the PDMP Electronic Health Records Integration and Interoperability Expansion, also known as PEHRIIE. PEHRIIE activities strengthen PDMP utilization by distributing PDMP data and increasing data sharing. Moreover, increasing knowledge of separate effective practices has helped many states reach advancements.[12]

Controversy[edit]

Many doctors and researchers consider PDMP's essential in combatting the opioid epidemic. Opioid prescribing, opioid diversion and supply, opioid misuse, and opioid-related morbidity and mortality are all elements in the design of PDMP's.[8] Prescription Monitoring Programs also offer economic benefits for the states who implement them. By decreasing overall health care costs, lost productivity, and investigation times, PDMP's are effective in reducing many effects of the opioid epidemic.[9]

However, there are many studies that conclude that the impact of PDMP’s is unclear.[8] There are only a few states that saw evidence for reduced opioid prescribing, shipments, and diversion of drug shipments, which propose a more conceptual method for evaluating PDMP’s in the future. The effectiveness of these programs is up to much dispute. When examining if PDMP implementation effects changes in nonfatal and fatal events, there is no definitive evidence whether PDMP implementation increased or decreased overdoses. Furthermore, although PDMP’s have been around for a long period of time, their impact is still unknown and unperfected.

Interestingly, an increase in heroin overdoses after PDMP implementation has been commonly reported.[13] Fink et al cited that due to the small sample size and isolated nature of the study this conclusion is drawn from, the deduction could be insignificant, but does highlight the possible negative repercussions that could emerge from prescription monitoring programs.[13]

Goals[edit]

Most health care workers support PMPs[14] which intend to assist physicians, physician assistants, nurse practitioners, dentists and other prescribers, the pharmacists, chemists and support staff of dispensing establishments, as well as law-enforcement agencies. The collaboration supports the legitimate medical use of controlled substances while limiting their abuse and diversion. Pharmacies dispensing controlled substances and prescribers typically must register with their respective state PMPs and (for pharmacies and providers who dispense controlled substances from their offices) report the dispensation to an electronic online database. Some pharmacy software can submit these reports automatically to multiple states.[15]

List of programs by state[edit]

State Name State Code Format Method Reporting Agency Schedules Monitored Documentation State Frequency Data Retention
Alaska AK ASAP 2009 v4.1 sFTP Appriss:855-525-4767 2 - 5 Source Monthly 2 Source
Alabama AL ASAP 2007 v4.0 sFTP Health Information Design Phone: 334.502.3262 2 - 5 Source Daily ?
Arkansas AR ASAP 2011 v4.2 sFTP Health Information Design Phone: 334.502.3262 ? ? Weekly ?
Arizona AZ ASAP 2005 v3.0 sFTP Health Information Design Phone: 334.502.3262 2 - 4 + Carisoprodol Source Daily Adult 6 / Minor 3 Source
California CA ASAP 2009 v4.1 sFTP Atlantic Associates, Inc Phone: 800.539.3370 2 - 4 Source Weekly 3 Source
Colorado CO ASAP 2012 v4.2 sFTP Health Information Design Phone: 334.502.3262 2 - 5 Source Bi-Weekly ?
Connecticut CT ASAP 4.2 FTPs Appriss:855-525-4767 2 - 5 Source Bi-Weekly ?
District of Columbia DC ASAP 4.2 ? ? ? ? ? ?
Delaware DE ASAP 2011 v4.2 sFTP Health Information Design Phone 334.502.3262 2 - 5 Source Daily ?
Florida FL ASAP 2009 v4.2 sFTP Health Information Design Phone: 334.502.3262 2 - 4 Source Weekly ?
Georgia GA ASAP 2011 V4.2 ? Appriss:855-525-4767 ? ? ? 1 Source
Hawaii HI ASAP 2009 v4.2 Web Portal Appriss:855-525-4767 2 - 5 + Carisoprodol Source Weekly https://hipdmpreporting.hidinc.com/
Idaho ID ASAP 2009 v4.1 sFTP Appriss:855-525-4767 2 - 5 Source Weekly ?
Illinois IL ASAP 2007 v4.0 sFTP Atlantic Associates, Inc Phone: 800.539.3370 2 - 5 Source Weekly 2 Source
Indiana IN ASAP 2007 v4.2 FTPs INSPECT Phone: 317.234.4458 Phone:866.683.2476 2 - 5 + Carisoprodol (SOMA) [1] Daily ?
Iowa IA ASAP v4.1 FTPs Optimum Technology, Inc Phone: 866.683.2476 2 - 4 Source BWeekly 4 Source
Kansas KS ASAP 2009 v4.1 sFTP Appriss:855-525-4767 2 - 4 + Drugs of Concern Source Daily ?
Kentucky KY ASAP 2009 v4.1 sFTP Health Information Design Phone: 334.502.3262 2 - 5 + Carisoprodol, Tramadol Source Daily 5 Source
Louisiana LA ASAP 4.2 sFTP Appriss:855-525-4767 2 - 5 + Tramadol, Butalibtal, Carisoprodol, Ephedrine, Pseudoephedrine, PPA Source Weekly ?
Massachusetts MA ASAP 2009 v4.1 sFTP Appriss:855-525-4767 2 - 5 Source Weekly ?
Maryland MD ASAP 2011 V4.2 sFTP Health Information Design Phone: 334.502.3262 2 - 4 Source Weekly ?
Maine ME ASAP 2009 v4.1 sFTP Appriss:855-525-4767 2 - 4 Source Bi-Weekly 6 Source
Michigan MI ASAP 2009 v4.1 Web Portal Michigan Automated Prescription System (MAPS) Source 2 - 5 Source Bi-Weekly ?
Minnesota MN ASAP 2007 v4.0 sFTP Health Information Design Phone: 334.502.3262 2 - 4 + Codeine containing cough syrups that are schedule 5 federally are schedule 3 in MN; Human growth hormones are schedule 3 in MN. Source Daily 1 Source
Missouri MO ASAP 4.2 ? ? ? ? ? 3 Source
Mississippi MS ASAP 2005 v3.0 sFTP Appriss:855-525-4767 2 - 5 + Butalbital, Carisoprodol, Soma, Tramadol Powder, Ultracet, Ultram ER, Ryzolt ER. [2] Weekly ?
Montana MT ASAP 4.2 sFTP Montana Prescription Drug Registry [3] ? ? Weekly ?
North Carolina NC ASAP 4.2 sFTP Health Information Design Phone: 334.502.3262 2 - 5 Source Weekly 6 Source
North Dakota ND ASAP 2009 v4.1 sFTP Health Information Design Phone: 334.502.3262 2 - 5 + Tramadol, Carisoprodol Source Daily ?
Nebraska NE ASAP 4.2 ? ? ? ? ? ?
New Hampshire NH ASAP 4.2 sFTP Appriss:855-525-4767 2 - 5 + Tramadol, Carisoprodol nhpdmpreporting.hidinc.com Daily ?
New Jersey NJ ASAP 2009 v4.1 sFTP Appriss:855-525-4767 2 - 5 and HCG [4] Weekly ?
New Mexico NM ASAP 2009 v4.1 Web Portal Appriss:855-525-4767 2 - 4 + Butalbital (Fioricet), Carisoprodol (Soma), Dezocine (Dalgan), Flunitrazepam (Rohypnol), Nalbuphine (Nubain), Pseudoephedrine (Sudafed) Source Weekly ?
Nevada NV ASAP 2005 v3.0 sFTP Appriss:855-525-4767 2 - 4 + Carisoprodol Source Weekly ?
New York NY ASAP 2007 v4.0 Web Portal New York (DOH & BNDD) Phone: 866.811.7957 2 - 5 + Chorionic Gonadotropin, HCG Source Daily 5 Source
Ohio OH ASAP 2009 v4.1 sFTP Ohio Automated Rx Reporting System (OARRS) Phone: 614.466.4143 2 - 5 + Carisoprodol, Tramadol Source Daily 2 Source
Oklahoma OK ASAP 2009 v4.1 Web Service Appriss:855-525-4767 2 - 5 + Tramadol Source Within 5 Minutes ?
Oregon OR ASAP 2009 v4.1 sFTP Health Information Design Phone: 334.502.3262 2 - 4 ? Weekly 3 Source
Pennsylvania PA ASAP 2007 v4.0 FTPs Appriss:855-525-4767 2 + ephedrine, pseudoephedrine, phenylpropanolamine, PSE ? Monthly ?
Rhode Island RI ASAP 4.2 Web Portal Prescription Monitoring Program (PMP) Phone: 401.222.2840 2 - 3 Source Monthly ?
South Carolina SC ASAP 4.2 sFTP Appriss:855-525-4767 2 - 4 Source Monthly ?
South Dakota SD ASAP 2009 v4.1 sFTP Appriss:855-525-4767 2 - 4 ? Weekly ?
Tennessee TN ASAP 2009 v4.1 FTPs Optimum Technology, Inc Phone: 866.683.2476 2 - 5 Source Bi-Weekly ?
Texas TX ASAP 2009 v4.1 FTPs Appriss:855-525-4767 2 - 5 + Carisoprodol Source Bi-Weekly 1 Source
Utah UT ASAP 4.2 Web Portal Utah Controlled Substance Database Program Phone: 801.530.6232 2 - 5 + butalbital w/acetaminophen Source Daily UCA 58-37f
Virginia VA ASAP 2009 v4.1 FTPs Appriss:855-525-4767 2 - 4 Source Bi-Weekly ?
Vermont VT ASAP 2005 v3.0 sFTP Appriss:855-525-4767 2 - 4 ? Weekly 6 Source
Washington WA ASAP 2011 v4.2 sFTP Health Information Design Phone: 334.502.3262 2 - 5 Source Weekly ?
Wisconsin WI ASAP 2011 v4.2 ? ? 2-5 + Tramadol ? ? ?
West Virginia WV ASAP 4.2 Web Portal West Virginia Board of Pharmacy 2 -4 Source ? ?
Wyoming WY ASAP 4.2 sFTP Atlantic Associates, Inc. Phone: 800.539.3370 2 - 4 + Tramadol, Carisoprodol Source Weekly ?

References[edit]

  1. ^ Sacco, Lisa N.; Duff, Johnathan H.; Sarata, Amanda K. (May 24, 2018). Prescription Drug Monitoring Programs (PDF). Washington, DC: Congressional Research Service. Retrieved 5 June 2018.
  2. ^ Rutkow, Lainie; Smith, Katherine C.; Lai, Alden Yuanhong; Vernick, Jon S.; Davis, Corey S.; Alexander, G. Caleb (2017). "Prescription drug monitoring program design and function: A qualitative analysis". Drug and Alcohol Dependence. 180: 395–400. doi:10.1016/j.drugalcdep.2017.08.040. PMID 28978492.
  3. ^ Rutkow L; Chang H; Daubresse M; et al. (2015). "EFfect of Florida's prescription drug monitoring program and pill mill laws on opioid prescribing and use". JAMA Internal Medicine. 175 (10): 1642–1649. doi:10.1001/jamainternmed.2015.3931. ISSN 2168-6106. PMID 26280092.
  4. ^ Pardo, Bryce (2017). "Do more robust prescription drug monitoring programs reduce prescription opioid overdose?". Addiction. 112 (10): 1773–1783. doi:10.1111/add.13741. PMID 28009931.
  5. ^ Addressing the Opioid Epidemic in New...)[full citation needed]
  6. ^ President Donald J. Trump's Initiative to Stop Opioid Abuse and Reduce Drug Supply and Demand. (n.d.). Retrieved from https://www.whitehouse.gov/briefings-statements/president-donald-j-trumps-initiative-stop-opioid-abuse-reduce-drug-supply-demand-2/
  7. ^ Department of Health. (n.d.). Retrieved from https://www.health.ny.gov/community/opioid_epidemic
  8. ^ a b c Finley, Erin P.; Garcia, Ashley; Rosen, Kristen; McGeary, Don; Pugh, Mary Jo; Potter, Jennifer Sharpe (20 June 2017). "Evaluating the impact of prescription drug monitoring program implementation: a scoping review". BMC Health Services Research. 17 (1). doi:10.1186/s12913-017-2354-5. PMC 5477729. PMID 28633638.
  9. ^ a b Briefing on PDMP Effectiveness. (2014). In Prescription Drug Monitoring Program Center of Excellence At Brandeis (p. 13). Brandeis University .
  10. ^ Thielking, M., Ross, C., Branswell, H., Hogan, A., & Associated Press. (2017, March 7). Missouri is the only state not tracking prescription drug use. Here’s why. Retrieved January 24, 2019, from https://www.statnews.com/2017/03/07/missouri-prescription-drug-database/
  11. ^ Lange, J; Gaddis, G; Varner, E; Schmidt, S; Cohen, R; Schwarz, E (2018). "Resident Access to the St. Louis County Prescription Drug Monitoring Program: Why PDMPs Matter and How to Gain Access". Missouri medicine. 115 (6): 487–493. PMID 30643325.
  12. ^ a b "Integrating & Expanding Prescription Drug Monitoring Program Data: Lessons from Nine States" (PDF). National Center for Injury Prevention and Control. February 2017.
  13. ^ a b Fink, David S.; Schleimer, Julia P.; Sarvet, Aaron; Grover, Kiran K.; Delcher, Chris; Castillo-Carniglia, Alvaro; Kim, June H.; Rivera-Aguirre, Ariadne E.; Henry, Stephen G.; Martins, Silvia S.; Cerdá, Magdalena (8 May 2018). "Association Between Prescription Drug Monitoring Programs and Nonfatal and Fatal Drug Overdoses". Annals of Internal Medicine. 168 (11): 783. doi:10.7326/M17-3074. PMC 6015770. PMID 29801093.
  14. ^ Hwang, Catherine S.; Turner, Lydia W.; Kruszewski, Stefan P.; Kolodny, Andrew; Alexander, G. Caleb (2016). "Primary Care Physicians' Knowledge And Attitudes Regarding Prescription Opioid Abuse and Diversion". The Clinical Journal of Pain. 32 (4): 279–284. doi:10.1097/ajp.0000000000000268. PMID 26102320.
  15. ^ Pharmacist's Manual. (n.d.). Retrieved from https://www.deadiversion.usdoj.gov/pubs/manuals/pharm2/pharm_content.htm

Further reading[edit]

  • Moyo, Patience; Simoni-Wastila, Linda; Griffin, Beth Ann; Onukwugha, Eberechukwu; Harrington, Donna; Alexander, G. Caleb; Palumbo, Francis (October 2017). "Impact of prescription drug monitoring programs (PDMPs) on opioid utilization among Medicare beneficiaries in 10 US States". Addiction. 112 (10): 1784–1796. doi:10.1111/add.13860. PMID 28498498.