The U.S. is in the midst of an opioid crisis. Deaths fromprescription painkiller overdoses have quadrupled since 1999. To combat theepidemic, 49 states and Washington, D.C., have built computersystems intended to detect when people try to get multipleprescriptions, either for their own use or to sell illegally.

|

The prescription drug monitoringprograms, or PDMPs, track patients who already have prescriptionsfor controlled substances and can alert prescribers if someoneappears to be “doctor-shopping.” The problem? They often goneglected by physicians.

|

Now advocates want stricter laws that require doctors to use thedatabases. Currently just seven states mandate that prescriberscheck the systems before giving patients opioids in all circumstances.More require them to get patients' prescription historyonly if they suspect abuse. There's no reliable data on howoften doctors use PDMPs, but evidence from such states as NewYork, Tennessee, and Kentucky show that they are used muchmore frequently when the law requires it.

|

Gary Mendell is among those pushing for the change. He foundedan advocacy group called Shatterproof after his son Brian, who hadstruggled with drug addiction, committed suicide in 2011 at age 25.Mendell, a former hotel executive, said the government needs torespond to the opioid crisis with the urgency of an epidemic suchas Ebola or Zika. “Human beings take time to change,” hesaid. "This will change over the next two decades unless there’surgency to it.”

|

Doctors say passing a law to make people use the databases won'tsolve the problem. "When they are fully funded, integrated into[electronic health records], and when they provide accurate,relevant, and real-time data, they can provide helpful clinicalinformation,” said Steven J. Stack, president of the AmericanMedical Association, in a statement.

|

"While some PDMPs can do this, many cannot." The doctors group“strongly supports” using the systems, Stack said, but they’re"only one piece of a much larger puzzle" to end the opioidcrisis.

|

“There are a tremendous number of barriers that have to beovercome for PDMPs to be used regularly at the point of care,”said Caleb Alexander, co-director of the Center for DrugSafety & Effectiveness at the Johns Hopkins BloombergSchool of Public Health. He signed on to a recent report fromShatterproof calling for mandatory use of PDMPs.

|

For example, requiring prescribers to log on with aseparate username and password is “a nonstarter” at manyhospitals, Alexander said. Even if the prescribing history isintegrated into the software doctors already use, it has to bedelivered at the right time and in a format that doctorsunderstand. "I think mandated use is long overdue, although theprograms have to be usable enough so that it’s reasonable tomandate them,” Alexander said.

|

New guidelines from the Centers for DiseaseControl call for doctors to consult PDMPs "to determinewhether the patient is receiving opioid dosages or dangerouscombinations that put him or her at high risk for overdose.”They’re just one part of a renewed national strategy to reduceopioid abuse. Every state but Missouri has authorized a PDMP, and theevidence in favor of the systems is growing, said CindyReilly, director of the prescription drug abuse project atthe Pew Charitable Trusts.

|

Just getting prescribers enrolled to use the systems can be achallenge. In 23 states, fewer than half of thepeople registered with the Drug Enforcement Agency toprescribe controlled substances wereenrolled in the PDMP in 2014, according to forthcoming researchfrom Pew.

|

There are some steps Reilly said states can take to make thesystems function better. Allowing prescribers to delegate checkingthe patient’s prescription history to other staff members can easethe burden on doctors in a rush. Likewise, the PDMPs should belinked seamlessly to electronic health records. The software shouldbe able to alert doctors to risky patterns and deliver theinformation in a meaningful, easy-to-understand way. Whilestates are progressively improving their systems, Reilly said,“it’s a slow-moving train.”

|

Mendell says the current pace is unacceptable. “If thiswere Ebola, and the government thought that 30,000 people might diethis year from Ebola, I don’t believe you would see evidence-basedsolutions and recommendations that would be implemented over thenext decade,” he said. "I believe you would see solutionsimplemented in weeks."

|

Copyright 2018 Bloomberg. All rightsreserved. This material may not be published, broadcast, rewritten,or redistributed.

Complete your profile to continue reading and get FREE access to BenefitsPRO, part of your ALM digital membership.

  • Critical BenefitsPRO information including cutting edge post-reform success strategies, access to educational webcasts and videos, resources from industry leaders, and informative Newsletters.
  • Exclusive discounts on ALM, BenefitsPRO magazine and BenefitsPRO.com events
  • Access to other award-winning ALM websites including ThinkAdvisor.com and Law.com
NOT FOR REPRINT

© 2024 ALM Global, LLC, All Rights Reserved. Request academic re-use from www.copyright.com. All other uses, submit a request to [email protected]. For more information visit Asset & Logo Licensing.