Prescription monitoring program

Most US health care workers support the idea of PMPs, which intend to assist physicians, physician assistants, nurse practitioners, dentists and other prescribers, the pharmacists, chemists and support staff of dispensing establishments. The database, whose use is required by State law, typically requires prescribers and pharmacies dispensing controlled substances to register with their respective state PMPs and (for pharmacies and providers who dispense from their offices) to report the dispensation of such prescriptions to an electronic online database. The majority of PMPs are authorized to notify law enforcement agencies or licensing boards or physicians when a prescriber, or patients receiving prescriptions, exceed thresholds established by the state or prescription recipient exceeds thresholds established by the State. All states have implemented PDMPs, although evidence for the effectiveness of these programs is mixed. While prescription of opioids has decreased with PMP use, overdose deaths in many states have actually increased, with those states sharing data with neighboring jurisdictions or requiring reporting of more drugs experiencing highest increases in deaths. This may be because those declined opioid prescriptions turn to street drugs, whose potency and contaminants carry greater overdose risk.

History

Prescription drug monitoring programs, or PDMPs, are an example of one initiative proposed 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 (i.e. “doctor shopping”) and reducing diversion of controlled substances. This is meant to reduce risk of fatal overdose caused by high doses of opioids or interactions between opioids and benzodiazepenes, and to enable better decision making on the part of healthcare providers who may be unaware of a patient's prescription drug use, history or other prescriptions.

PDMPs have been implemented in state legislations since 1939 in California, a time before electronic medical records, though implementation rose alongside increased awareness of overprescribing of opioids and overdose. A later New York state program was struck down by the U.S. Supreme Court in Whalen v. Roe. But, by 2019, 49 states, the District of Columbia, and Guam had enacted PDMP legislation. In 2021 Missouri, the last State to not use a PMP, adopted legislation to create one.

PMPs are constantly being updated to increase speed of data collection, sharing of data across States, and ease of interpretation. This is being done by integrating PDMP reports with other health information technologies such as health information exchanges (HIE), electronic health record (EHR) systems, and/ or pharmacy dispensing software systems. One program that has been implemented in nine states is called the PDMP Electronic Health Records Integration and Interoperability Expansion, also known as PEHRIIE. Another software, marketed by Bamboo Health and integrated with PMPs in 43 states, uses an algorithm to track factors thought to increase risk of diversion, abuse or overdose, and assigns patients a three digit score based on presumed indicators of risk. While some studies have suggested that PDMP-HIT integration and sharing of interstate data brings benefits such as reduced opioid-related inpatient morbidity, others have found no or negative impact on mortality compared to states without PMP data sharing. Patient and media reports suggest need for testing and evaluation of algorithmic software used to score risk, with some patients reporting denial of prescriptions without c explanation or clarity of data.