HIT Perspectives – February 2017
PDMPs Take on Renewed Importance as a Tool in the Fight Against the Opioid Epidemic
By Connie Sinclair, Senior Consultant
Prescription drug monitoring programs (PDMPs) created to address drug abuse and diversion, are independent, state-run databases of controlled substance prescriptions. Until recently, they existed in relatively obscure, seldom-used silos. Then, the opioid problem became an epidemic that hit the nation with rapidly mounting deaths and overdoses. According to government statistics, drug overdosing is the leading cause of accidental death in the United States. An estimated 91 Americans die every day from an opioid overdose.
This tragic turn of events has caused officials at the federal and state levels to consider how PDMPs could become an even more effective tool in fighting opioid abuse and diversion. In response, states are ramping up legislative requirements for their use. Stakeholders are looking at ways of increasing interoperability of PDMPs, and we expect to hear a lot more about them in 2017.
Why PDMPs? PDMPs are being increasingly viewed as a key tool in the fight against abuse and diversion of prescription drugs. They collect data from pharmacies, outpatient hospital pharmacies, outpatient clinics and other data submitters on dispensed controlled substance prescriptions. They capture data regarding quantities of and to whom controlled substance medications have been dispensed. Checking this information before writing prescriptions for controlled substances — and before the medications are dispensed — can help identify potential drug abusers and doctor shopping. All states (except Missouri) have established a PDMP. The federal government recently gave $8.8 million in 20 separate awards to 19 state health and pharmacy boards and departments in support of PDMPs.
Use of PDMPs is gaining traction because they have proven effective. According to a new study by Vanderbilt University researchers, implementation of state PDMPs was associated with the prevention of approximately one opioid-related overdose death every two hours, on average, nationwide. Results are seen at the state level as well. New York requires prescribers to check the state database before prescribing controlled substances. Since the mandate began in 2013, the state reported a 75% drop in the number of patients using multiple prescribers and pharmacies to acquire controlled prescription drugs. Florida is another example. In concert with related policies targeting inappropriate opioid prescribing, Florida found that oxycodone-caused mortality declined 25% in the month immediately following implementation of its PDMP.
States pass or consider new PDMP laws. Due to the success of PDMPs and the continued rise of the opioid epidemic, state lawmakers have stepped up regulatory and legislative mandates related to PDMP use. In California, a September 29, 2016 law created a broad mandate for prescribers to access the state PDMP before prescribing any controlled substance under schedule II, III or IV. This makes California the 26th state to require prescribers to review PDMP records before writing a controlled substance prescription.
Numerous other states have bills in the works related to PDMPs, although their requirements could change if and when they make it as far as enactment. For example, Kentucky is trying to alert the PDMP to any person convicted of a felony related to controlled substances so clinicians can take that into consideration when these patients request a controlled substance prescription. States like New York, New Jersey and West Virginia are proposing that prescriptions for naloxone-type drugs (for the reversal of an opioid overdose) be reported to the PDMP. Pennsylvania will be offering patients a non-opiate directive form which allows patients to stipulate they do not want opiates prescribed for them. This directive is to be documented in the PDMP and in the EHR, so prescribers can see it before writing a prescription for controlled substances.
Legislation related to documenting or reducing opioid use continues to be introduced. A bill in Massachusetts would mandate electronic prescribing of controlled substances, while another in New Jersey would mandate all such prescriptions to be electronic. Proposed legislation in New Jersey also would require a 3-day default limit in electronic health records (EHRs) involving opioid drugs.
PDMP pilots. Despite the success of PDMPs in fighting drug abuse and diversion, it is time to take them to the next level and improve their interoperability. Currently, PMDPs have limited interoperability with EHRs and pharmacy systems because they are based on a completely different operating platform and data exchange model. For additional details, see the article in the April 2016 issue of HIT Perspectives.
With those issues in mind, the Office of the National Coordinator for Health Information Technology (ONC) convened a large, multistakeholder group to evaluate how use of current technology and standards for EHRs and pharmacy systems affect interoperability with PDMPs. These efforts resulted in pilots, and those sites and participants are summarized on the initiative’s website. Emphasis was placed on assessing the ability to query the PDMP database by EHRs and pharmacy systems, as well as return accurate responses to the requestors. An implementation guide was produced.
The pilots recently concluded and seven of 10 participating vendors are now moving PDMP functionality into production, leveraging the final implementation guide. Appriss has indicated that many EHRs are indeed integrating to its PDMP gateway.
Moving forward. While the war against prescription drug abuse is far from over, stakeholders are ramping up to fight even stronger. It will be interesting to see how results of the pilot are taken into production and implemented. We hope there will be an evaluation component that will further move the ball down the field. We expect to see more pilots as stakeholders look to resolve data gaps as well as technical and legal issues that limit data exchange and retention.
We also expect to see more state legislation aimed at making PDMPs an even more important tool in fighting the opioid abuse epidemic. Point-of-Care Partners is on top of those efforts. Our ePrescribing State Law Review was created to keep companies current with federal and state regulatory changes so they can proactively identify opportunities and modifications that may be needed. Subscribers receive ongoing, in-depth analyses of relevant prescribing rules and have access to POCP regulatory experts. An abbreviated summary, the ePrescribing State Law Capsule, is available on a complimentary basis.