In the United States, prescription monitoring programs or prescription drug monitoring programs 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. 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 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.
Definition
In the United States, prescription monitoring programs or prescription drug monitoring programs 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. 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."
History
Prescription drug monitoring programs, or PDMPs, are an example of one initiative in place to alleviate effects of the opioid crisis. The programs are designed to restrict prescription drug abuse by limiting a patient’s ability to obtain similar prescriptions from multiple providers and reducing diversion of controlled substances. PDMPs may also enable better decision making on the part of healthcare providers. PDMPs have been implemented in state legislations since 1939 in California, a time before researchers were aware of the highly addictive properties of opioids. Since 2014, 49 states and one US territory have enacted PDMP legislation. Of the 49, 48 have utilized the programs. As of December, 2019, Missouri is the only state within the United States that does not maintain a PMP or PDMP. 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 such as health information exchanges, electronic health record systems, and/ or pharmacy dispensing software systems. 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.
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. 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. However, there are many studies that conclude the impact of PDMPs is unclear. 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. 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.
Goals
Most 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 typically must register with their respective state PMPs and report the dispensation to an electronic online database. Some pharmacy software can submit these reports automatically to multiple states.
