Before writing a prescription, doctors should be fully informed about their patient’s prescribing history and current medications. That’s just common sense. Unfortunately, this doesn’t happen more than 75% of the time.
When used correctly and regularly, Prescription Drug Monitoring Programs (PDMPs) are an effective tool to prevent opioid addiction and accidental overdoses. These systems allow doctors to check their patient’s prescription history before writing a new or refill prescription for a powerful drug that carries overdose risk, like an opioid, or for a potentially dangerous combination of medications, like an opioid co-prescribed with a benzodiazepine. And crucially, if a PDMP check reveals that a patient may be struggling with a substance use disorder, that should result in a referral to treatment—not a termination of care.
There’s good evidence that PDMPs work in states. Take New York, for example. In the first year that the state mandated the use of PDMPs in 2013, doctor shopping decreased by 75%, the number of opioid doses dispensed decreased by 10%, and the number of prescriptions for buprenorphine, a drug used to treat opioid addiction, increased by 15%.
We could see results like this in every state if key PDMP requirements are put in place at a federal level. This federal oversight would make all the difference—instead of being just another database, every state’s PDMPs could become a truly effective, lifesaving tool.
Shatterproof recommends the following PDMP standards for states to receive any PDMP funding, all of which have been recommended in numerous white papers as critical best practices:
- Require that every prescriber check the PDMP for schedule II, III and IV substances at the first prescribing event, and at least every 90 days thereafter
- Require pharmacists to enter dispensing information into the PDMP within 24 hours
- Require states to include the most recent 12 months of prescription history (at a minimum) in the PDMP
- Allow Medicare, Medicaid, health plans and pharmacy benefit managers to request access to state PDMP information
While the recently-passed opioid legislation, the SUPPORT Act (H.R. 6), did not include all of the above, many of these standards will see more adherence thanks to two major PDMP provisions included in H.R. 6:
- CONNECTIONS Act, which authorizes the Centers for Disease Control and Prevention (CDC) support and funding for states to improve their PDMPs and implement evidence-based prevention strategies
- Medicaid PARTNERSHIP Act, which will require Medicaid providers to check their state’s PDMP before prescribing a Schedule II controlled substance, like oxycodone, by October 1, 2021. The provision also establishes standards for a “qualified PDMP”, including that the prescribing history must be integrated into the provider’s clinical workflow to make it easier to review and the state must share PDMP data with contiguous states to prevent doctor shopping.
Shatterproof will continue to push for mandatory PDMP checks for all providers.
Beyond PDMPs, there are steps we can take to prevent unregulated, highly potent, and dangerous substances from entering America's illicit drug supply. To advance this policy area, Shatterproof will continue to advocate for The Fentanyl Sanctions Act (H.R. 2483/ S. 1044) to make the trafficking of fentanyl to the U.S. more difficult.