The Strengths, Limitations, and Scope of Prescription Drug Monitoring Programs (PDMP)

What PDMP gets right, and where we still have room for improvement

Prescription Drug Monitoring Programs (PDMP’s) are designed to decrease diversion, abuse, and doctor shopping by showing the controlled substance history of a patient--usually spanning 2 years. PDMP inquiry is mandated in several states before writing a script for a controlled substance, and recent studies demonstrate a reduction in opioid-related consequences.

PMDP utilization has resulted in fewer opioid prescriptions being written and is a valuable tool in reducing opioid abuse. The Centers for Disease Control and Prevention (CDC) advises: “Clinicians should review PDMP data when starting opioid therapy for chronic pain and periodically during opioid therapy for chronic pain, ranging from every prescription to every three months.”  PDMP data allows the prescriber to identify aberrant behavior and is significant only if the prescriber uses this information in addition to clinical input, physical examination, psychosocial assessment, and demographic information.

Although research demonstrates PDMP effectiveness when utilized prior to writing controlled substances, research also identifies some limitations when inquiring about PDMP data. Prescribers already inundated with dynamic requirements from several various agencies are trying to maintain the balance of treating patients with controlled substances to improve the patient’s overall function and quality of life while confirming that they are not adding to or enabling suspicious activities.

PDMP data inquiry and analysis and whether the prescriber can provide evidence of this due diligence is often overlooked and unknown.  In the unfortunate case of an investigation or lawsuit, if a prescriber cannot prove that on any particular day, even if it is years before, the prescriber could be seen as negligent. Checking the PDMP data is vital, and if there is no evidence of a date/time-stamp, it is unfortunately as if the data was never inquired at all.  Having tight documentation of the due-diligence of correctly interpreting the provided data is essential, and a prescriber should be able to reproduce this with the click of a button no matter how long ago the case goes back to.

Many prescribers focus on the recent data provided on the PDMP to rule out doctor shopping or cross-contamination with multiple controlled substances. Practical constraints usually prevent prescribers from attempting to go back years before to identify any suspicious patterns.  The PDMP is effective when determining recent prescription filling history, but it can take several hours to do a thorough analysis when attempting to attempt data from several months prior.  

PDMP data is not always integrated within a prescriber’s workflow, requiring office staff to log in to multiple websites, which can be time consuming and expensive.  Besides, practices located in states bordering others must analyze data from bordering state PDMP databases to rule out patients who fill from multiple pharmacies.  PDMP inquiry for each patient can take minutes, which only accumulates to the administrative burdens.

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