Prescription Drug Monitoring: A Tool For Pharmacists

According to the National Institute of Drug Abuse (NIDA), prescription drug abuse is defined as the intentional use of medication without a prescription or the use of medication for experiences or feeling other than prescribed.

Prescription drug abuse has been identified as one of the fastest growing drug problems in the United States. Seven million individuals aged 12 and older were either non-medical users of prescription medications or were on psycho-therapeutic drugs.

Results from several national surveys show that next to marijuana, prescription medications are being abused at an alarming rate among illicit drug users. The prescription medications being abused include those used to treat pain, attention deficit disorders, and/or anxiety. The surge in prescription drug abuse has increased the rates of admission to rehabilitation facilities, emergency room visits, and deaths due to overdose.

In response to curbing the abuse, most states have adopted prescription drug monitor programs (PDMPs) to track controlled substance prescription dispensing history. In all states, PDMPs maintain electronic databases of information on specific prescription drugs that are dispensed in the states.

The information collected varies from state to state. In general, the information gathered by the PDMPs may include: patient name, date of birth, address, medication name, medication strength, and date and quantity dispensed, also in cases like, for example, hearing loss on the workplace. PDMPs can also collect the name of the prescribing physician, doctor DEA, date(s) prescription was issued and dispensed.

This information is available to organizations and individuals authorized under laws of the states. Pharmacists, licensing boards, prescribers, law enforcement, or other healthcare professionals are authorized to access this information that also includes details about who is using which blood glucose meter and that sort of details.

Healthcare providers can utilize this information to better assess whether a prescription in question is being overused, abused, or diverted. PDMPs can also facilitate a better identification of drug-addicted persons and provide them with treatment options. Some of the other advantages include providing law enforcement evidence regarding the diversion or insurance fraud.

Moreover, it also enables professional licensing boards to identify clinicians that demonstrate patterns of inappropriate prescribing thereby reduce doctor shopping or pill mills. Ultimately, the goal of the PDMPs is to improve patient safety and the quality of care.

According to the Alliance of States with Prescription Drug Monitoring Programs, 48 states have operational PDMPs or have passed laws to implement them. Texas, being one of the authorized states, has what is known as the Prescription Access in Texas (PAT), which was developed by the Texas Department of Public Safety (DPS).

PAT is a secured, online prescription drug monitoring program, where authorized users have access to track the last 365 days of prescription dispensing history for Schedule II V controlled substances. This information is available online to authorized users.

Under the Texas Health & Safety Code, Chapter 481, authorized users of the PAT include: law enforcement, pharmacists, practitioners (i.e. physicians, dentists, veterinarians, podiatrists, or advanced practice nurses or physician assistants), and board investigators.

Depending on the type of access granted, this database enables users to view a certain patient and prescribing information. For instance, law enforcement can access practitioner prescribing information, pharmacy dispensing information, and patient prescription information, while practitioners can access their patients prescribing information and their own prescribing information.

On the other hand, pharmacists can only access their patients dispensed prescription history. The data found online is constantly updated since pharmacies are required by the Texas Health & Safety Code to report prescription dispensing histories within seven days. See also this post about how antioxidants may be the solution to optimal health.

In order to obtain access to PAT, an authorized user (practitioner, mid-level, pharmacist, or law enforcement) must register online and provide licensing information. Once registration is complete, it takes seven to ten days for new registrants to be approved and gain access.

A literature review provided evidence suggesting that PDMPs are essential tools for both law enforcement and health care providers to prevent prescription drug abuse. A review article from 2012 summarizing all peer review articles about PDMPs concluded that the use of PDMPs prevented drug shoppers and reduced the time and effort spent by regulatory agencies in drug diversion cases.

However, the literature also suggests that the overall impact of the usage of PDMPs on decreasing opioid consumption or drug overdose mortality has not been clinically significant. While the literature does not provide solid evidence that the use of PDMPs improves mortalities due to drug overdose and abuse, PDMPs have changed the culture of prescribing controlled substances and thereby reduced prescription abuse.

While opioid abuse has been increasing as a national problem, the rate of increase is slower in states that utilize PDMPs. While PDMPs have proved useful in preventing diversion, the efficacy of PDMPs needs improvement through standardization, sharing data across states, also about diabetes patients, and real-time data updates.

This can be achieved by increasing professional awareness and training to decrease the hesitancy of utilizing PDMPs among healthcare providers and by integrating electronic prescription technology, all seen from a student’s perspective.

For pharmacists, this online database will provide a valuable tool in the community as well as the hospital pharmacy setting. In community settings, pharmacists are often in situations where patients are suspected of abusing their medications based on the dispensing history of a specific pharmacy location.

This mere suspicion may not always provide the needed evidence to confidently deny filling a controlled substance prescription. Furthermore, without a universal prescription tracking system, patients could easily deny using multiple pharmacies to fill controlled substances.

The use of PDMPs provides factual information gathered from multiple pharmacies that can confirm poly-pharmacy, doctor shopping, and drug abuse. From anecdotal experiences in the community pharmacy settings, pharmacists have witnessed fewer incidences of drug abuse by patients with the use of PDMPs.

In a hospital setting, access to this database can be used to detect patients with multiple hospital admissions or emergency admissions for the sole purpose of obtaining controlled substances such as pain medications for abuse purposes.

This tool will help physicians to better distinguish patients with true cases of pain versus those that are merely pill seekers. This all allows physicians to better identify prescription drug abuse and refer patients accordingly.

Some of the concerns with using the PDMPs are the additional time required to access the database and generate the patient-specific report as well as the feeling that policing the public goes beyond the scope of pharmacy practice.

Thus, some pharmacists may neglect the use of the PDMPs and dispense the medication in question to the patient. However, pharmacists, although not yet required to in Texas, should take proactive roles in accessing the PDMP and reviewing the information before dispensing narcotic medications. See also this post about pregnant women and diabetes.

Even though there is no explicit algorithm guiding what a pharmacist should do with the information provided by the PDMPs, pharmacists should use this information along with their professional judgment to help reduce illicit use of prescriptions while supporting legitimate uses. Failure to do so jeopardizes the safety of patients and the quality of care pharmacists are supposed to provide.

In addition, patients improperly using narcotic medications endanger the general public. News articles report car accidents and incidents where innocents are harmed by someone improperly using or abusing a prescription medication.

A few extra minutes to properly assess the legitimacy and appropriateness of a prescription through the use of the PDMP are negligible if it means a life is saved. As pharmacists, we should embrace this additional tool as it will help us add value to the profession and to healthcare.

According to the Center for Disease Control, prescription drug abuse is described as an epidemic due to the additional burden and cost it causes the national government. PDMPs are an essential tool to curb prescription drug abuse and change the culture of prescribing a controlled substance. The information available from PDMPs would enable pharmacists to make decisions that improve patient outcomes.

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