The Office of National Drug Control Policy’s 2011 Prescription Drug Abuse Prevention Plan, calling for immediate action to reduce prescription-drug diversion and abuse, was announced at a White House press conference in April¹. The plan’s four-pronged approach comprises:

• Education: For health care providers and patients, including parents and youth.
• Tracking and monitoring: With primary focus on strengthening and expanding prescription-drug-monitoring programs.
• Proper medication disposal: Increasing medication takeback activities and consumer education on safe methods of disposal and return.
• Enforcement: Strengthening law enforcement’s role in stopping practitioners and providers who illegally prescribe or dispense controlled substances, which endangers individuals as well as communities.

Enhancement and increased utilization of prescription drug monitoring programs will help to identify “doctor shoppers” and detect therapeutic duplication and drug-drug interactions.

Prescription drug monitoring programs (PDMPs) are often not familiar to clinicians even though they currently exist in more than half of the states. For a PDMP to be successful, clinicians need to know what it is, how it works, how to determine if it is effective, and how to get detailed information about it in the state where they practice.

The definition of a PDMP, according to the U.S. Department of Justice, Drug Enforcement Administration (DEA), following the National Alliance for Model State Drug Laws (NAMSDL), is a statewide electronic database that collects designated data on substances dispensed in the state. PDMP data are housed in a specified statewide regulatory, administrative, or law enforcement agency. The agency distributes the information from the database to individuals authorized under state law to receive it for purposes of their profession. The DEA is not involved with the administration of any state PDMP².

According to NAMSDL, a PDMP is intended to:

• Support access to legitimate medical use of controlled substances by providing an additional way for clinicians to check patients’ compliance.
• Identify and deter or prevent drug abuse and diversion by helping clinicians to determine if a patient is misusing a medication.
• Facilitate and encourage the identification and treatment of people addicted to prescription drugs by helping clinicians to detect evidence of a substance abuse disorder and initiate an appropriate intervention.
• Inform public health initiatives through outlining drug use and abuse trends in the state and providing this information to policymakers and health care providers.
• Facilitate education of health care professionals and the public about PDMPs, as well as the use, abuse, diversion of, and addiction to prescription drugs, through state-managed websites and print publications.

As of May 2011, 35 states had operational PDMPs with the capacity to receive and distribute controlled-substance prescription information to authorized users. Thirteen states, one U.S. territory, and the District of Columbia had enacted legislation to establish PDMPs, but they were not yet in operation.

The specific elements of a PDMP currently vary from state to state. A PDMP’s usefulness may be limited by the following factors:

• Information not always being available in real time.
• Difficulties with clinician access, including ease of registration and speed of obtaining information for clinical decision-making.
• Lack of information-sharing among bordering states, making it possible for patients to get around the system by filling prescriptions in another state.
• Not enough dissemination of information about the PDMP, resulting in fewer clinicians knowing about and using the program.

On the basis of experience with existing PDMPs, the question remaining is, do they work? Dr. Aaron Gilson, of the University of Wisconsin’s School of Medicine and Public Health, states that, “PMPs have proliferated in the last 2 decades, but only about 10 research articles have been published… Therefore, little is known about the success of PMPs in identifying and reducing doctor shopping.”³ Anecdotal evidence suggests that individual health care providers have found PDMPs to be helpful with clinical decision-making because they provide new, otherwise unavailable information about patients.

If the 2011 Prescription Drug Abuse Prevention Plan does result in a PDMP in every state and if states use the data effectively and share information, the goal of decreasing drug abuse, addiction, and diversion is likely to be met.

Clinicians can learn more about their state’s PDMP by visiting the Alliance of States with Monitoring Programs website, www.pmpalliance.org.

References

1. Epidemic: Responding to America’s Prescription Drug Abuse Crisis. Http://www.whitehousedrugpolicy.gov/publications/pdf/rx_abuse_plan.pdf

2. U.S. Department of Justice, Drug Enforcement Administration, Office of Diversion Control. Questions & Answers. State Prescription Drug Monitoring Programs. Http://www.deadiversion.usdoj.gov/faq/rx_monitor.htm

3. Prescription Monitoring Programs: Do They Work? Http://www.medscape.com/viewarticle/724487