How America's Prescription Drug Addiction Crisis May Get a Whole Lot Worse
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"Monitoring" means using a prescription drug monitoring program (PDMP). A PDMP is an electronic database of patients' prescription histories. It's supposed to tackle the abuse problem at the source.
The drug policy firm Carnavale Associates has called PDMPs the "silver bullet for ending the prescription drug epidemic."
A PDMP serves two aims. First, it is designed to prevent people from doctor shopping: getting multiple prescriptions for the same drug from multiple doctors. The second is to give the law enforcement and medical communities a better idea of which doctors are overprescribing.
PDMPs already exist in New York and 42 other states and laws have been passed that will require them to be created in every remaining state except for Missouri. Oklahoma was the first state to create an electronic PDMP back in 1991. After it became clear that the prescription drug problem had become a national problem, other states followed Oklahoma's lead.
Each state's PDMP is different. Many are voluntary and don't require doctors or pharmacists to actually use them at all. As of January, Oklahoma requires pharmacists and doctors who actually dispense the drugs to report a prescription into the database immediately after filling the prescription, but doesn't have the same mandate for the prescriber.
Oklahoma's is managed by law enforcement, New York's is managed by the health department. Many can't even be accessed by law enforcement without a warrant.
The Justice Department encourages states to share their PDMP data with one of two interstate hubs designed to allow people looking at the database in one state to see if a patient has prescriptions in another state. These are both new tools, and because different kinds of agencies have access to the PDMP from state to state, many pharmacies and physicians don't share information with these interstate hubs.
"Many years ago it was decided that it would be better to allow states to manage their own individual databases, because they could be more responsive and gather information to give back to people in their state," said Sherry Green, executive director of the National Alliance for Model State Drug Laws.
She explained that while the states are responsible for implementing their own PDMPs, the federal government still exerts some control because it controls much of their funding.
"There are two grant programs from the federal level. One is through the Justice Department and one is through the Health Department, and both give grants to state programs. If there are certain things they want states to do they'll incentivize them through the grant program," said Green.
The source of these two funding streams, one medical and one law enforcement-based, mirror the dual role of the PDMPs themselves -- as both a crime-fighting tool against doctor-shopping and a public health tool to prevent doctors from over-prescribing. The lines between the two are often blurred, which can be problematic for people dealing directly with prescription drug abuse and the researchers trying to understand the drug problem.
In regard to their role as a crime-fighting tool, PDMPs have one glaring defect: they give doctors and pharmacists days, often weeks, to input prescriptions into the system. In the meantime, someone looking to go to multiple other doctors still has a window in which to do it: the very problem that the real-time requirement in New York is designed to solve.
That's also the problem that Oklahoma's real-time requirement is designed to solve, but in a very different way. Just as the PDMPs themselves have spread to almost every state, real-time is the next level that's about to be tested across the nation.