Prescription monitoring program

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][2]

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. [3]

Definition

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.[4][5] 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."[6]

History

Prescription drug monitoring programs, or PDMPs, are an example of one initiative in place to alleviate effects of the opioid crisis.[1] The programs are designed to restrict prescription drug abuse by limiting a patient’s ability to obtain similar prescriptions from multiple providers (i.e. “doctor shopping”) and reducing diversion of controlled substances. PDMPs may also enable better decision making on the part of healthcare providers.[7]

PDMPs 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] As of December, 2019, Missouri is the only state within the United States that does not maintain a PMP or PDMP.[10]

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 providers’ 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.[11]

A specific program that has been implemented in 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.[11]

Controversy

Many doctors and researchers consider PDMPs an essential tool in combatting the opioid epidemic. Opioid prescribing, opioid diversion and supply, opioid misuse, and opioid-related morbidity and mortality are common elements in the design of PDMPs.[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, PDMPs are effective in reducing many effects of the opioid epidemic.[9]

However, there are many studies that conclude the impact of PDMPs 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 PDMPs 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 PDMPs 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.[12] 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.[12]

Goals

Most health care workers support PMPs[13] 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.[14]

List of programs by state

State NameState CodeFormatMethodReporting AgencySchedules MonitoredDocumentationState FrequencyData Retention
AlaskaAKASAP 2009 v4.1sFTPAppriss:855-525-47672 - 5SourceMonthly2 Source
AlabamaALASAP 2007 v4.0sFTPHealth Information Design Phone: 334.502.32622 - 5SourceDaily?
ArkansasARASAP 2011 v4.2sFTPHealth Information Design Phone: 334.502.3262??Weekly?
ArizonaAZASAP 2005 v3.0sFTPHealth Information Design Phone: 334.502.32622 - 4 + CarisoprodolSourceDailyAdult 6 / Minor 3 Source
CaliforniaCAASAP 2009 v4.1sFTPAtlantic Associates, Inc Phone: 800.539.33702 - 4SourceWeekly3 Source
ColoradoCOASAP 2012 v4.2sFTPHealth Information Design Phone: 334.502.32622 - 5SourceBi-Weekly?
ConnecticutCTASAP 4.2FTPsAppriss:855-525-47672 - 5SourceBi-Weekly?
District of ColumbiaDCASAP 4.2??????
DelawareDEASAP 2011 v4.2sFTPHealth Information Design Phone 334.502.32622 - 5SourceDaily?
FloridaFLASAP 2009 v4.2sFTPHealth Information Design Phone: 334.502.32622 - 4SourceWeekly?
GeorgiaGAASAP 2011 V4.2?Appriss:855-525-4767???1 Source
HawaiiHIASAP 2009 v4.2Web PortalAppriss:855-525-47672 - 5 + CarisoprodolSourceWeeklyhttps://hipdmpreporting.hidinc.com/
IdahoIDASAP 2009 v4.1sFTPAppriss:855-525-47672 - 5SourceWeekly?
IllinoisILASAP 2007 v4.0sFTPAtlantic Associates, Inc Phone: 800.539.33702 - 5SourceWeekly2 Source
IndianaINASAP 2007 v4.2FTPsINSPECT Phone: 317.234.4458 Phone:866.683.24762 - 5 + Carisoprodol (SOMA)Daily?
IowaIAASAP v4.1FTPsOptimum Technology, Inc Phone: 866.683.24762 - 4SourceBWeekly4 Source
KansasKSASAP 2009 v4.1sFTPAppriss:855-525-47672 - 4 + Drugs of ConcernSourceDaily?
KentuckyKYASAP 2009 v4.1sFTPHealth Information Design Phone: 334.502.32622 - 5 + Carisoprodol, TramadolSourceDaily5 Source
LouisianaLAASAP 4.2sFTPAppriss:855-525-47672 - 5 + Tramadol, Butalibtal, Carisoprodol, Ephedrine, Pseudoephedrine, PPASourceWeekly?
MassachusettsMAASAP 2009 v4.1sFTPAppriss:855-525-47672 - 5SourceWeekly?
MarylandMDASAP 2011 V4.2sFTPHealth Information Design Phone: 334.502.32622 - 4SourceWeekly?
MaineMEASAP 2009 v4.1sFTPAppriss:855-525-47672 - 4SourceBi-Weekly6 Source
MichiganMIASAP 2009 v4.1Web PortalMichigan Automated Prescription System (MAPS) Source2 - 5SourceBi-Weekly?
MinnesotaMNASAP 2007 v4.0sFTPHealth Information Design Phone: 334.502.32622 - 4 + Codeine containing cough syrups that are schedule 5 federally are schedule 3 in MN; Human growth hormones are schedule 3 in MN.SourceDaily1 Source
MissouriMOASAP 4.2?????3 Source
MississippiMSASAP 2005 v3.0sFTPAppriss:855-525-47672 - 5 + Butalbital, Carisoprodol, Soma, Tramadol Powder, Ultracet, Ultram ER, Ryzolt ER.Weekly?
MontanaMTASAP 4.2sFTPMontana Prescription Drug Registry ??Weekly?
North CarolinaNCASAP 4.2sFTPHealth Information Design Phone: 334.502.32622 - 5SourceWeekly6 Source
North DakotaNDASAP 2009 v4.1sFTPHealth Information Design Phone: 334.502.32622 - 5 + Tramadol, CarisoprodolSourceDaily?
NebraskaNEASAP 4.2??????
New HampshireNHASAP 4.2sFTPAppriss:855-525-47672 - 5 + Tramadol, Carisoprodolnhpdmpreporting.hidinc.comDaily?
New JerseyNJASAP 2009 v4.1sFTPAppriss:855-525-47672 - 5 and HCGWeekly?
New MexicoNMASAP 2009 v4.1Web PortalAppriss:855-525-47672 - 4 + Butalbital (Fioricet), Carisoprodol (Soma), Dezocine (Dalgan), Flunitrazepam (Rohypnol), Nalbuphine (Nubain), Pseudoephedrine (Sudafed)SourceWeekly?
NevadaNVASAP 2005 v3.0sFTPAppriss:855-525-47672 - 4 + CarisoprodolSourceWeekly?
New YorkNYASAP 2007 v4.0Web PortalNew York (DOH & BNDD) Phone: 866.811.79572 - 5 + Chorionic Gonadotropin, HCGSourceDaily5 Source
OhioOHASAP 2009 v4.1sFTPOhio Automated Rx Reporting System (OARRS) Phone: 614.466.41432 - 5 + Carisoprodol, TramadolSourceDaily2 Source
OklahomaOKASAP 2009 v4.1Web ServiceAppriss:855-525-47672 - 5 + TramadolSourceWithin 5 Minutes?
OregonORASAP 2009 v4.1sFTPHealth Information Design Phone: 334.502.32622 - 4?Weekly3 Source
PennsylvaniaPAASAP 2007 v4.0FTPsAppriss:855-525-47672 + ephedrine, pseudoephedrine, phenylpropanolamine, PSE?Monthly?
Rhode IslandRIASAP 4.2Web PortalPrescription Monitoring Program (PMP) Phone: 401.222.28402 - 3SourceMonthly?
South CarolinaSCASAP 4.2sFTPAppriss:855-525-47672 - 4SourceMonthly?
South DakotaSDASAP 2009 v4.1sFTPAppriss:855-525-47672 - 4?Weekly?
TennesseeTNASAP 2009 v4.1FTPsOptimum Technology, Inc Phone: 866.683.24762 - 5SourceBi-Weekly?
TexasTXASAP 2009 v4.1FTPsAppriss:855-525-47672 - 5 + CarisoprodolSourceBi-Weekly1 Source
UtahUTASAP 4.2Web PortalUtah Controlled Substance Database Program Phone: 801.530.62322 - 5 + butalbital w/acetaminophenSourceDailyUCA 58-37f
VirginiaVAASAP 2009 v4.1FTPsAppriss:855-525-47672 - 4SourceBi-Weekly?
VermontVTASAP 2005 v3.0sFTPAppriss:855-525-47672 - 4?Weekly6 Source
WashingtonWAASAP 2011 v4.2sFTPHealth Information Design Phone: 334.502.32622 - 5SourceWeekly?
WisconsinWIASAP 2011 v4.2??2-5 + Tramadol???
West VirginiaWVASAP 4.2Web PortalWest Virginia Board of Pharmacy2 -4Source??
WyomingWYASAP 4.2sFTPAtlantic Associates, Inc. Phone: 800.539.33702 - 4 + Tramadol, CarisoprodolSourceWeekly?

References

  1. Islam MM, McRae IS (2014). "An inevitable wave of prescription drug monitoring programs in the context of prescription opioids: pros, cons and tensions". BMC Pharmacol Toxicol. 15 (46). doi:10.1186/2050-6511-15-46. PMID 25127880.
  2. 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.
  3. 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.
  4. 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.
  5. "AMA report shows evolving, deadlier overdose epidemic". American Medical Association. Retrieved 10 October 2020.
  6. 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.
  7. Department of Health. (n.d.). Retrieved from https://www.health.ny.gov/community/opioid_epidemic
  8. 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. 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. "Integrating & Expanding Prescription Drug Monitoring Program Data: Lessons from Nine States" (PDF). National Center for Injury Prevention and Control. February 2017.
  12. 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.
  13. 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.
  14. Pharmacist's Manual. (n.d.). Retrieved from https://www.deadiversion.usdoj.gov/pubs/manuals/pharm2/pharm_content.htm

Further reading

  • 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.
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