More states urged to mandate physician use of prescription drug monitoring databases

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As the number of drug overdose deaths linked to prescription painkillers continues to rise, experts are calling on more states to set mandates requiring prescribers to check state prescription drug monitoring programs prior to writing a prescription.

Every state except Missouri operates a PDMP, which monitors, collects and stores data on prescriptions in order to flag bad behavior either by a physician who over-prescribes or by a patient who seeks multiple prescriptions.

But the databases have gone largely unused. Physicians say they are time-consuming, often requiring prescribers to sign out of their electronic health record systems and into another database. Some states, like Missouri, have refused to create PDMPs because they feel the patient records may not remain private.

A new report released this week by the Pew Charitable Trusts and Brandeis University looks to address some of these challenges.

The report identified eight best practices that could improve utilization. Among the recommendations was a call for states to mandate enrollment, something that 27 states have done.

That requirement was originally included within the Comprehensive Addiction and Recovery Act, which was passed by Congress this past summer. It gave states money to create drug monitoring programs if the state mandated their use. But physician groups won their lobbying efforts to exclude the provision in the final version of the bill.

Another bill in the Senate that would have made the same requirements has since stalled in committee.

Other best practices include allowing others on staff to access the PDMP as a way to manage workflow, as well as having PDMPs regularly warn prescribers of potential drug abuse by patients based their prescribing data.

The report also called for better integration of PDMP data into electronic health records for more seamless use, as well as instituting an automatic PDMP registration for a simpler enrollment process.

Researchers said the most effective recommendation was the mandate.

A study published in June in Health Affairs found prescribing of Schedule II opioids declined by 30% among 24 states from 2001 to 2010 after they began operating PDMPs.

More than 33,000 deaths occurred in 2015 as a result of drug overdose from prescription opioids, according to the latest figures from the Centers for Disease Control and Prevention. That number surpasses those who died from car accidents or gun violence that year.

– Stephan Ross Johnson, Modern Healthcare

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The AAOS recommends the following tools, which have been shown to significantly reduce medication errors:

  • computerized physician order entry
  • computerized decision support systems
  • computerized monitoring of adverse drug events
  • pharmacist-assisted rounds
  • high-risk drug protocols

Overdose deaths are “just the tip of the iceberg”: that for every death there are many more hospital treatment admissions, emergency room visits, people who abuse or are dependent on prescription drugs and nonmedical users.

American Psychological Association

What prescribers can do to safely and effectively use opioids for CNCP (includes the following)

  • Screen for prior or current substance abuse/misuse
  • Do not use concomitant sedative–hypnotics or benzodiazepines
  • Track daily MED using an online dosing calculator
  • Use the state Prescription Drug Monitoring Program to monitor all sources of controlled substances

Neurology, 2014; 83; 1277-1284, September 2014
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