Despite challenges, prescription drug monitoringprograms are essential tools in ensuring opioids and other addictive medicinesare prescribed and used appropriately.
The field of medicine is being pulled in two directions. On one hand, doctors are becoming more aware of the consequences of pain, leading to the prescription of more and more aggressive pain medicines; and on the other hand, we are also becoming more aware of the addictive potential of many of these drugs. We see the necessity of using opioid painkillers for people in pain, but we see the destructiveness of these painkillers when mis-prescribed and/or misused.
One response to this dilemma has been the growth of prescription drug monitoring programs (PDMPs). PDMPs allow doctors to know who is getting what drugs from whom.That's the promise of a PDMP – it can keep track of the doctors who are prescribing drugs, the pharmacists who are distributing them, and the patients who are using them, and will allow people in positions of authority along this chain of communication to ensure that dangerous and addictive drugs are being used cautiously and correctly.
An interesting article in the open access journal BMC Pharmacy and Toxicology explores the pros and also the cons of these PDMPs – and lists the challenges we need to answer as we further refine the use of these important programs.
Here are the"pros" the article lists: Reduce over prescription and doctor shopping; reduce fraudulent prescribing by physicians; improve quality of care(e.g. ensuring there are no accidental drug interactions from legitimate prescriptions); and track geographic trends of use (e.g. discovering geographic trends of misuse and also demographic trends in legitimate use).
Here are the"cons" the article lists: Physician concerns (e.g. concern that legitimate, high prescribers will be unfairly flagged); tagging of “pseudo addicts” (e.g. patients who have legitimately moved between doctors searching for real pain relief); patient concerns about refusal of prescriptions; loss of privacy; interference of law enforcement with health care; and mandatory use of PDMPs forcing unnecessary demands on doctors' already stretched time.
In my opinion, these prescription drug monitoring programs are somewhat similar to asking police officers to wear video recorders; prescribers who are doing their job well have nothing to worry about and, in fact, an extra layer of careful oversight may help many providers answer concerns about their legitimate prescribing patterns. When you're doing a good job, it can be supportive to have someone watching. Physicians who are in hospice or palliative care, someof the fields that prescribe opioids more than other specialties, will also have support through tracking of their prescribing practices.
Of course,answering the remaining concerns becomes a challenge of doing the most good compared to the least bad. A carefully designed PDMP should flag more doctor-shopping addicts and patients at risk for addiction than it flags patients receiving legitimate prescriptions for chronic, debilitating pain, palliative care, or acute situations. In these cases of inappropriately flagged patients,individual reviews can ensure that people who are in pain receive the drugs they need. We need also to ensure in these processes that reviews are quick,made by medical professionals (not non-medical administrators), and that patients have access to critical medications during the review process.
Are prescription drug monitoring programs worth their drawbacks? What’s your opinion?
Richard Taite is founder and CEO of Cliffside Malibu, offering evidence-based, individualized addiction treatment based on the Stages of Change model. He is also co-author with Constance Scharff of the book Ending Addiction for Good.