<strong>Prescription</strong> <strong>Drug</strong> <strong>Monitoring</strong> <strong>Programs</strong>: An Assessment <strong>of</strong> the Evidence for Best Practices 2• Section III provides an overview <strong>of</strong> the paper’s methods and discusses types <strong>of</strong> evidence foreffectiveness, the relative strength <strong>of</strong> the methods and evidence, and how the current evidencebase for potential <strong>PDMP</strong> best practices was assessed.• Section IV describes candidate <strong>PDMP</strong> best practices, the extent to which they are implemented by<strong>PDMP</strong>s, and the evidence base for each practice, and identifies barriers to their adoption.• Section V discusses conclusions and recommendations regarding <strong>PDMP</strong> best practices. It includes atable summarizing the types <strong>of</strong> evidence that currently exist for each practice and the strength andconsistency <strong>of</strong> evidence within those types. This section also outlines a research agenda, suggestingthe kinds <strong>of</strong> studies needed to produce a stronger evidence base for practices we believe have thegreatest potential to improve <strong>PDMP</strong> effectiveness.• Section VI provides the references we have examined in developing this white paper. Thesereferences are summarized in two tables in an appendix: one providing an overview <strong>of</strong> the peer-‐‐reviewed, published literature on <strong>PDMP</strong> practices and effectiveness, and a second providing anoverview <strong>of</strong> other literature <strong>of</strong> evaluation studies and reports, case studies, anecdotal information,and expert opinion.
<strong>Prescription</strong> <strong>Drug</strong> <strong>Monitoring</strong> <strong>Programs</strong>: An Assessment <strong>of</strong> the Evidence for Best Practices 3II. BackgroundA brief history <strong>of</strong> <strong>PDMP</strong>sThrough 1989, nine <strong>PDMP</strong>s had been established. Two were located in state Attorneys General <strong>of</strong>fices(California, 1939 and Pennsylvania, 1972); two in Departments <strong>of</strong> Public Safety (Hawaii, 1943 and Texas,1981); two in Departments <strong>of</strong> Health, Bureau <strong>of</strong> Narcotics Enforcement (New York, 1970 and RhodeIsland, 1978); one in a Department <strong>of</strong> Substance Abuse Services (Illinois, 1961); one in a Board <strong>of</strong>Pharmacy (Idaho, 1967); and one in a Department <strong>of</strong> Consumer Affairs, Bureau <strong>of</strong> Health Pr<strong>of</strong>essions(Michigan, 1988). All <strong>of</strong> these programs collected information about Schedule II prescriptions 1 only, andall used state-‐issued serialized prescription forms. The use <strong>of</strong> these multiple-‐page forms allowed theoriginal prescription records to be sent to the <strong>PDMP</strong> for key-‐punch data entry, while the pharmacy, andin most cases the prescriber, kept a copy.Reflecting their locations primarily in state agencies concerned with public safety and drug enforcement,these early <strong>PDMP</strong>s all provided solicited reports, and most provided unsolicited reports to lawenforcement personnel and regulatory agencies or pr<strong>of</strong>essional licensing agencies. None provided reportsto prescribers or pharmacists. The reports and, where relevant, <strong>PDMP</strong> investigations focused onprescribers selling prescriptions, pharmacies selling controlled substances illegally, and organized doctorshopping rings. For example, narcotics enforcement in New York, using <strong>PDMP</strong> data, focused onQuaalude and barbiturate prescription abuse associated with sleep clinics in the late 1970s and early1980s, and subsequently on stimulant prescription abuse associated with weight clinics (Eadie, 2010).With support from the U.S. <strong>Drug</strong> Enforcement Administration (DEA), the existing <strong>PDMP</strong> administratorscreated the Alliance <strong>of</strong> States with <strong>Prescription</strong> <strong>Monitoring</strong> <strong>Programs</strong> in November 1990. The Alliancewas founded to provide a forum for support and information exchange among <strong>PDMP</strong>s, states whereefforts were under way to establish a <strong>PDMP</strong>, and states where creation <strong>of</strong> a <strong>PDMP</strong> was beingconsidered. At this time, <strong>PDMP</strong>s expanded data collection beyond Schedule II prescriptions. In thecontext <strong>of</strong> computer-‐based information technologies, a second generation <strong>of</strong> <strong>PDMP</strong>s came intoexistence that collected prescription information electronically, without the use <strong>of</strong> serializedprescription forms. Examples included the Oklahoma <strong>PDMP</strong> in 1990, located in the Department <strong>of</strong> PublicSafety, and the Massachusetts <strong>PDMP</strong> in 1992, located in the Department <strong>of</strong> Public Health.The Nevada <strong>PDMP</strong>, implemented in 1997 and located in the state Board <strong>of</strong> Pharmacy, ushered in a newera <strong>of</strong> <strong>PDMP</strong>s by providing data directly to prescribers and pharmacists. Initially, Nevada proactively sentunsolicited reports to the health care practitioners who had issued and dispensed prescriptions to1The Controlled Substances Act, passed in 1970, established the five-‐tiered schedule <strong>of</strong> controlled substances thatis now in effect. <strong>Drug</strong>s are assigned to one <strong>of</strong> these categories, or schedules, based on the substance’s medicinalvalue, harmfulness, and potential for abuse and diversion. Schedule II is the most restrictive <strong>of</strong> the schedules <strong>of</strong>legally available controlled substances.
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