Prescribing controlled substances has become dynamically more challenging, as the administrative tasks associated with prescribing continues to grow. Prescribers must rule out the possibility of doctor shopping (patient fills a controlled substance from multiple physicians) and doctor hopping (patient travels far from their residence to obtain controlled substances).
Before the patient encounter, a significant component of the pre-visit procedures is to inquire, analyze, scrutinize, and interpret the data on the Prescription Drug Monitoring Program( PDMP) to specifically examine the possibility of a patient filling controlled substances from multiple prescribers. PDMPs are in place to not only rule out doctor shopping and diversion but are also used to track the number of controlled substances a provider prescribes over a period of time and compares a provider’s prescribing habits to another practitioner. In addition, law enforcement utilizes the PDMP as well in relevant investigations. State requirements continue to vary regarding the frequency of PDMP inquiries however, the CDC recommends at least quarterly and to consider checking before every controlled substance prescription. A common practice amongst the medical community has been to utilize these databases and are becoming more mainstream, as they provide information that the patient may withhold during the encounter.
The state-run Prescription Drug Monitor Programs (PDMPs) provide information regarding controlled substance prescribing trends, details of the prescriber and pharmacies, quantity and type of controlled substance filled, and method of payment. An essential component of prescribing controlled substances is to rule out any potential drug interactions that could be harmful. For example, if a patient is on daily opioid analgesics and is given a benzodiazepine, this significantly increases the chance of addiction and overdose. The state PDMP is utilized to identify prescriber habits of prescribing controlled substances to identify potential outliers in dispensing these addictive medications.
PDMP databases have an extensive amount of essential and vital information that can be challenging to unpack in the allocated time before the patient visit. Fill date and quantity of the drug filled provide information on whether or not the patient is filling controlled drugs on overlapping dates. The name of the prescriber and the pharmacy the medication was filled provide the necessary information of whether or not the patient is obtaining medications from multiple prescribers and if the patient is filling at multiple pharmacies in order to attempt to bypass the system. Another component of the PDMP that is often overlooked is the payment method, as if the transaction is conducted with cash while the patient has health insurance can often identify suspicious behavior.
Administrative duties, which include PDMP inquiry prior to prescribing any controlled substance comes with its challenges. Now that we have synopsized the necessary factors that are obtainable on the PDMP, we will discuss the challenges of the PDMP that prescribers and their delegates face.