Prescription Drug Monitoring Programs - PDMP Center of Excellence

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Prescription Drug Monitoring Programs: An Assessment of the Evidence for Best Practices 36Current adoption status: Depending on the state, PDMP end users typically include prescribers,dispensers, medical licensing boards, and law enforcement investigators. Some PDMPs, however, havewidened their user base to include medical examiners, drug treatment programs and treatmentprofessionals, criminal justice diversion programs such as drug courts, “pre-‐criminal” interventionprograms (PDMP COE, NFF, 2.1), and drug prevention initiatives (PDMP COE, NFF 3.2). WashingtonState’s new PDMP provides data to Medicaid, the Workers’ Compensation unit in the Department ofLabor and Industries, and the Corrections Department (communication from PDMP administrator). A2012 statute authorizes the New York State PDMP to provide data to local health departments forpurposes of public research and education. Other categories of users could include health care systems’peer review organizations (the North Dakota PDMP is authorized to provide data to peer revieworganizations) and third-‐party payers’ health care professional reviewers.PDMPs with more inclusive data access policies can serve as models for programs seeking to expand theiruser base. For example, Kentucky’s PDMP permits use of its data by drug diversion investigators (PDMPCOE, NFF 2.3) and drug courts (PDMP COE, NFF 2.4), Virginia’s by medical examiners (PDMP COE, NFF2.6), and other states by outpatient drug treatment programs (PDMP COE, NFF 2.2). A compilationof all appropriate end users, developed in consultation with state PDMPs and the PDMP Training andTechnical Assistance Center, would provide direction in maximizing appropriate use of PDMP data.Developing case studies of how data are applied by these end users and in innovative applications (seethe PDMP COE “NFF” series) will also assist in moving this process forward.Barriers to adoption: Barriers to permitting greater access to PDMP data include the absence of specificauthorization for certain users written into a state’s enabling PDMP legislation and/or regulations;concerns of prescribers and pharmacies about professional licensing boards or law enforcement agenciesbeing able to see information about their prescribing and dispensing behavior (sometimes described asfear of so-‐called “fishing expeditions” by investigators); concerns about revealing the identity of patientsin drug treatment programs; lack of PDMP resources to undertake outreach and legislative initiatives;and lack of awareness of PDMPs on the part of potential end users.SummaryRationale: Permitting and encouraging use of PDMP data by all appropriate users, and in innovativeapplications, will help to maximize PDMP utilization and impact.Evidence of effectiveness: Case studies.Current adoption status: States vary in restricting or encouraging use of PDMP by different categories ofusers.Barriers to adoption: Legislative prohibitions on PDMP data access by potential users, concerns aboutmisuse of data by law enforcement and substance abuse treatment agencies, lack of awareness ofPDMP.B. Outreach and recruitment strategiesEnrollment in and use of PDMPs by medical practitioners is key to achieving their full potential in helpingto ensure safe prescribing and dispensing, and in reducing diversion and abuse of controlled substances.
Prescription Drug Monitoring Programs: An Assessment of the Evidence for Best Practices 37One of the most significant challenges facing PDMPs has been the slow increase in enrollment in and useof PDMPs by prescribers and pharmacists. Rates of enrollment among prescribers are well below 50percent in most states. 4 Best practices, therefore, need to be identified for how PDMPs can mostefficiently increase enrollment among user groups, including producing enrollments of, for example, atleast 50 percent of those who wrote 10 or more controlled substance prescriptions in the past year, orof prescribers of at least 50 percent of prescriptions written.To inform best practices in this domain, appropriate rates of enrollment need to be studied, taking intoaccount that many providers prescribe infrequently and that a relatively small proportion of prescribersare responsible for issuing most controlled substance prescriptions. Data from the Massachusetts PDMPindicate that just 30 percent of all those who prescribed an opioid at least once in 2011 wereresponsible for 88 percent of all opioid prescriptions in 2011 (MADPH Advisory Council Presentation,2012). This suggests that to maximize the effectiveness of PDMPs, recruitment strategies couldprofitably be focused on the most frequent prescribers of those controlled substances implicated inabuse and diversion (see immediately below).1. Proactively identify and conduct outreach to potential high-‐impact usersRationale and evidence for effectiveness: Certain categories of potential PDMP users are a high priorityfor enrollment given the impact their use of PDMP data would likely have in improving prescribing anddispensing, and in reducing diversion and abuse of prescription drugs. Primary among these are the mostfrequent prescribers of controlled substances, such as the top 10 percent in terms of prescriptions peryear (Paulozzi, 2011), as well as those prescribers with relatively high proportions of suspected doctorshoppers in their practices. Such prescribers are readily identifiable using PDMP data and can beencouraged to enroll in and use the PDMP via letters and alerts, either electronically or by mail. In 2010,Utah’s PDMP analyzed its data to identify top prescribers, then contacted them electronically, resultingin a rapid rise in enrollment among this group. Massachusetts is currently conducting an initiative toidentify prescribers with relatively high proportions of doctor shoppers in their practices; theseprescribers are receiving letters suggesting they join and use the Massachusetts PDMP. Theseprescribers’ enrollment in and utilization of the PDMP will be monitored, along with any changes thatmay occur in the proportion of possible doctor shoppers in their practices.Current adoption status: Contact with other PDMPs is warranted to ascertain which are engaged insimilar efforts and assess outcomes, including on enrollment, utilization, prescribing, doctor shoppingrates, and proportions of doctor shoppers among identified frequent prescribers. Outreach to frequentprescribers for enrollment in the PDMP will need to be coordinated with licensure boards andinvestigative agencies in case any of the identified practitioners happen to be subjects of disciplinaryaction or investigations.4According to data during the first half of 2010 from Harold Rogers PDMP Grant Program, of 12 PDMPs withoperational online Web portals for prescribers to request prescription history reports, 11 reported 9 to 39 percentof prescribers who issued controlled substances prescriptions were registered. Only one state (Hawaii) reported100 percent registration.
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