Pushing the Boundaries:
Regionalized PDMPs Helping To Slow the Opioid Epidemic

ENGLEWOOD, N.J.—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.

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.

“This is the kind of thing that is going to save lives,” he said. “And it will make the job of our health care providers much easier.”

– Donald M. Pizzi, Pain Medicine News
May 4, 2016

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Prescription drug monitoring programs (PDMPs) are now active in most states to assist clinicians in identifying potential controlled drug misuse, diversion, or excessive prescribing. Little is still known about the ways in which they are incorporated into workflow and clinical decision making, what barriers continue to exist, and how clinicians are sharing PDMP results with their patients.

Design
Qualitative data were collected through online focus groups and telephone interviews.

Setting
Clinicians from pain management, emergency and family medicine, psychiatry/behavioral health, rehabilitation medicine, internal medicine and dentistry participated.

Patients
Thirty-five clinicians from nine states participated.

Methods
We conducted two online focus groups and seven telephone interviews. A multidisciplinary team then used a grounded theory approach coupled with an immersion–crystallization strategy for identifying key themes in the resulting transcripts.

Results
Some participants, mainly from pain clinics, reported checking the PDMP with every patient, every time. Others checked only for new patients, for new opioid prescriptions, or for patients for whom they suspected abuse. Participants described varied approaches to sharing PDMP information with patients, including openly discussing potential addiction or safety concerns, avoiding discussion altogether, and approaching discussion confrontationally. Participants described patient anger or denial as a common response and noted the role of patient satisfaction surveys as an influence on prescribing.

Conclusion
Routines for accessing PDMP data and how clinicians respond to it vary widely. As PDMP use becomes more widespread, it will be important to understand what approaches are most effective for identifying and addressing unsafe medication use.

Pain Medicine, Volume 15, Issue 7, July 2014 

Effective monitoring systems [PDMPs] will augment clinical judgment, provide evidence of misuse, and facilitate prescription of the most appropriate analgesic for the situation…The Emergency Department is regarded as the nation’s safety net…the last bastion of around-the-clock access to care … Unfortunately, some of the solutions to opioid misuse [limiting ED physicians to 3-day opioid prescriptions] preempts judgments from trained emergency medical providers.

American College of Physicians, Annals of Internal Medicine, 9 April 2013

Rick Bunker is a co-founder, and the CEO of Prescription Advisory Systems and Technology (P.A.S.T.). In this role, he is responsible for capital formation and corporate development.

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