Prescription monitoring program

In the United States, prescription monitoring programs (PMPs) or prescription drug monitoring programs (PDMPs) are state-run programs which collect and distribute data about the prescription and dispensation of federally controlled substances and, as the individual states deem appropriate, other potentially addictive or abusable prescription drugs. PMPs help to prevent adverse drug-related events through opioid overdoses, drug diversion, and substance abuse by decreasing the amount and/or frequency of opioid prescribing.[1][2]

Most US health care workers support PMPs, which intend to assist physicians, physician assistants, nurse practitioners, dentists and other prescribers, the pharmacists, chemists and support staff of dispensing establishments, as well as law-enforcement agencies. The collaboration supports the legitimate medical use of controlled substances while limiting their abuse and diversion. Pharmacies dispensing controlled substances and prescribers are typically required to register with their respective state PMPs and (for pharmacies and providers who dispense controlled substances from their offices) to report the dispensation of such prescriptions to an electronic online database. Although forty-nine states have implemented PDMPs, little is known about these programs and their overall effectiveness. [3]

Definition

In the United States, prescription monitoring programs (PMPs) or prescription drug monitoring programs (PDMPs) are state-run programs which collect and distribute data about the prescription and dispensation of federally controlled substances and, as the individual states deem appropriate, other potentially addictive or abusable prescription drugs. PMPs help to prevent adverse drug events through opioid overdoses, drug diversion, and substance abuse by decreasing the amount and/or frequency of opioid prescribing.[4] A 2017 study found that "US states that have more robust prescription drug monitoring programs have fewer prescription opioid overdose deaths than states with weaker PMPs."[5]

History

Prescription drug monitoring programs, or PDMPs, are an example of one initiative in place to alleviate effects of the opioid crisis.[1] The programs are designed to restrict prescription drug abuse by limiting a patient’s ability to obtain similar prescriptions from multiple providers (i.e. “doctor shopping”) and reducing diversion of controlled substances. PDMPs may also enable better decision making on the part of healthcare providers.[6]

PDMPs have been implemented in state legislations since 1939 in California, a time before researchers were aware of the highly addictive properties of opioids.[7] Since 2014, 49 states and one US territory have enacted PDMP legislation. Of the 49, 48 have utilized the programs.[8] As of December, 2019, Missouri is the only state within the United States that does not maintain a PMP or PDMP.[9]

Although prescription drug monitoring programs are not new to state legislation, they are constantly being updated for the current healthcare climate. Currently, a major goal is to streamline provider access and improve providers’ understanding of PDMP reports. This is being done by integrating PDMP reports into health information technologies (HITs) such as health information exchanges (HIE), electronic health record (EHR) systems, and/ or pharmacy dispensing software (PDS) systems.[10]

A specific program that has been implemented in nine states is called the PDMP Electronic Health Records Integration and Interoperability Expansion, also known as PEHRIIE. PEHRIIE activities strengthen PDMP utilization by distributing PDMP data and increasing data sharing. Moreover, increasing knowledge of separate effective practices has helped many states reach advancements.[10]

Controversy

Many doctors and researchers consider PDMPs an essential tool in combatting the opioid epidemic. Opioid prescribing, opioid diversion and supply, opioid misuse, and opioid-related morbidity and mortality are common elements in the design of PDMPs.[7] Prescription Monitoring Programs also offer economic benefits for the states who implement them. By decreasing overall health care costs, lost productivity, and investigation times, PDMPs are effective in reducing many effects of the opioid epidemic.[8]

However, there are many studies that conclude the impact of PDMPs is unclear.[7] There are only a few states that saw evidence for reduced opioid prescribing, shipments, and diversion of drug shipments, which propose a more conceptual method for evaluating PDMPs in the future. The effectiveness of these programs is up to much dispute. When examining if PDMP implementation effects changes in nonfatal and fatal events, there is no definitive evidence whether PDMP implementation increased or decreased overdoses. Furthermore, although PDMPs have been around for a long period of time, their impact is still unknown and unperfected.

Interestingly, an increase in heroin overdoses after PDMP implementation has been commonly reported.[11] Fink et al cited that due to the small sample size and isolated nature of the study this conclusion is drawn from, the deduction could be insignificant, but does highlight the possible negative repercussions that could emerge from prescription monitoring programs.[11]

Goals

Most health care workers support PMPs[12] which intend to assist physicians, physician assistants, nurse practitioners, dentists and other prescribers, the pharmacists, chemists and support staff of dispensing establishments, as well as law-enforcement agencies. The collaboration supports the legitimate medical use of controlled substances while limiting their abuse and diversion. Pharmacies dispensing controlled substances and prescribers typically must register with their respective state PMPs and (for pharmacies and providers who dispense controlled substances from their offices) report the dispensation to an electronic online database. Some pharmacy software can submit these reports automatically to multiple states.[13]

List of programs by state

State Name	State Code	Format	Method	Reporting Agency	Schedules Monitored	Documentation	State Frequency	Data Retention
Alaska	AK	ASAP 2009 v4.1	sFTP	Appriss:855-525-4767	2 - 5	Source	Monthly	2 Source
Alabama	AL	ASAP 2007 v4.0	sFTP	Health Information Design Phone: [phone]	2 - 5	Source	Daily	?
Arkansas	AR	ASAP 2011 v4.2	sFTP	Health Information Design Phone: [phone]	?	?	Weekly	?
Arizona	AZ	ASAP 2005 v3.0	sFTP	Health Information Design Phone: [phone]	2 - 4 + Carisoprodol	Source	Daily	Adult 6 / Minor 3 Source
California	CA	ASAP 2009 v4.1	sFTP	Atlantic Associates, Inc Phone: [phone]	2 - 4	Source	Weekly	3 Source
Colorado	CO	ASAP 2012 v4.2	sFTP	Health Information Design Phone: [phone]	2 - 5	Source	Bi-Weekly	?
Connecticut	CT	ASAP 4.2	FTPs	Appriss:855-525-4767	2 - 5	Source	Bi-Weekly	?
District of Columbia	DC	ASAP 4.2	?	?	?	?	?	?
Delaware	DE	ASAP 2011 v4.2	sFTP	Health Information Design Phone [phone]	2 - 5	Source	Daily	?
Florida	FL	ASAP 2009 v4.2	sFTP	Health Information Design Phone: [phone]	2 - 4	Source	Weekly	?
Georgia	GA	ASAP 2011 V4.2	?	Appriss:855-525-4767	?	?	?	1 Source
Hawaii	HI	ASAP 2009 v4.2	Web Portal	Appriss:855-525-4767	2 - 5 + Carisoprodol	Source	Weekly	https://hipdmpreporting.hidinc.com/
Idaho	ID	ASAP 2009 v4.1	sFTP	Appriss:855-525-4767	2 - 5	Source	Weekly	?
Illinois	IL	ASAP 2007 v4.0	sFTP	Atlantic Associates, Inc Phone: [phone]	2 - 5	Source	Weekly	2 Source
Indiana	IN	ASAP 2007 v4.2	FTPs	INSPECT Phone: [phone] Phone:[phone]	2 - 5 + Carisoprodol (SOMA)		Daily	?
Iowa	IA	ASAP v4.1	FTPs	Optimum Technology, Inc Phone: [phone]	2 - 4	Source	BWeekly	4 Source
Kansas	KS	ASAP 2009 v4.1	sFTP	Appriss:855-525-4767	2 - 4 + Drugs of Concern	Source	Daily	?
Kentucky	KY	ASAP 2009 v4.1	sFTP	Health Information Design Phone: [phone]	2 - 5 + Carisoprodol, Tramadol	Source	Daily	5 Source
Louisiana	LA	ASAP 4.2	sFTP	Appriss:855-525-4767	2 - 5 + Tramadol, Butalibtal, Carisoprodol, Ephedrine, Pseudoephedrine, PPA	Source	Weekly	?
Massachusetts	MA	ASAP 2009 v4.1	sFTP	Appriss:855-525-4767	2 - 5	Source	Weekly	?
Maryland	MD	ASAP 2011 V4.2	sFTP	Health Information Design Phone: [phone]	2 - 4	Source	Weekly	?
Maine	ME	ASAP 2009 v4.1	sFTP	Appriss:855-525-4767	2 - 4	Source	Bi-Weekly	6 Source
Michigan	MI	ASAP 2009 v4.1	Web Portal	Michigan Automated Prescription System (MAPS) Source	2 - 5	Source	Bi-Weekly	?
Minnesota	MN	ASAP 2007 v4.0	sFTP	Health Information Design Phone: [phone]	2 - 4 + Codeine containing cough syrups that are schedule 5 federally are schedule 3 in MN; Human growth hormones are schedule 3 in MN.	Source	Daily	1 Source
Missouri	MO	ASAP 4.2	?	?	?	?	?	3 Source
Mississippi	MS	ASAP 2005 v3.0	sFTP	Appriss:855-525-4767	2 - 5 + Butalbital, Carisoprodol, Soma, Tramadol Powder, Ultracet, Ultram ER, Ryzolt ER.		Weekly	?
Montana	MT	ASAP 4.2	sFTP	Montana Prescription Drug Registry	?	?	Weekly	?
North Carolina	NC	ASAP 4.2	sFTP	Health Information Design Phone: [phone]	2 - 5	Source	Weekly	6 Source
North Dakota	ND	ASAP 2009 v4.1	sFTP	Health Information Design Phone: [phone]	2 - 5 + Tramadol, Carisoprodol	Source	Daily	?
Nebraska	NE	ASAP 4.2	?	?	?	?	?	?
New Hampshire	NH	ASAP 4.2	sFTP	Appriss:855-525-4767	2 - 5 + Tramadol, Carisoprodol	nhpdmpreporting.hidinc.com	Daily	?
New Jersey	NJ	ASAP 2009 v4.1	sFTP	Appriss:855-525-4767	2 - 5 and HCG		Weekly	?
New Mexico	NM	ASAP 2009 v4.1	Web Portal	Appriss:855-525-4767	2 - 4 + Butalbital (Fioricet), Carisoprodol (Soma), Dezocine (Dalgan), Flunitrazepam (Rohypnol), Nalbuphine (Nubain), Pseudoephedrine (Sudafed)	Source	Weekly	?
Nevada	NV	ASAP 2005 v3.0	sFTP	Appriss:855-525-4767	2 - 4 + Carisoprodol	Source	Weekly	?
New York	NY	ASAP 2007 v4.0	Web Portal	New York (DOH & BNDD) Phone: [phone]	2 - 5 + Chorionic Gonadotropin, HCG	Source	Daily	5 Source
Ohio	OH	ASAP 2009 v4.1	sFTP	Ohio Automated Rx Reporting System (OARRS) Phone: [phone]	2 - 5 + Carisoprodol, Tramadol	Source	Daily	2 Source
Oklahoma	OK	ASAP 2009 v4.1	Web Service	Appriss:855-525-4767	2 - 5 + Tramadol	Source	Within 5 Minutes	?
Oregon	OR	ASAP 2009 v4.1	sFTP	Health Information Design Phone: [phone]	2 - 4	?	Weekly	3 Source
Pennsylvania	PA	ASAP 2007 v4.0	FTPs	Appriss:855-525-4767	2 + ephedrine, pseudoephedrine, phenylpropanolamine, PSE	?	Monthly	?
Rhode Island	RI	ASAP 4.2	Web Portal	Prescription Monitoring Program (PMP) Phone: [phone]	2 - 3	Source	Monthly	?
South Carolina	SC	ASAP 4.2	sFTP	Appriss:855-525-4767	2 - 4	Source	Monthly	?
South Dakota	SD	ASAP 2009 v4.1	sFTP	Appriss:855-525-4767	2 - 4	?	Weekly	?
Tennessee	TN	ASAP 2009 v4.1	FTPs	Optimum Technology, Inc Phone: [phone]	2 - 5	Source	Bi-Weekly	?
Texas	TX	ASAP 2009 v4.1	FTPs	Appriss:855-525-4767	2 - 5 + Carisoprodol	Source	Bi-Weekly	1 Source
Utah	UT	ASAP 4.2	Web Portal	Utah Controlled Substance Database Program Phone: [phone]	2 - 5 + butalbital w/acetaminophen	Source	Daily	UCA 58-37f
Virginia	VA	ASAP 2009 v4.1	FTPs	Appriss:855-525-4767	2 - 4	Source	Bi-Weekly	?
Vermont	VT	ASAP 2005 v3.0	sFTP	Appriss:855-525-4767	2 - 4	?	Weekly	6 Source
Washington	WA	ASAP 2011 v4.2	sFTP	Health Information Design Phone: [phone]	2 - 5	Source	Weekly	?
Wisconsin	WI	ASAP 2011 v4.2	?	?	2-5 + Tramadol	?	?	?
West Virginia	WV	ASAP 4.2	Web Portal	West Virginia Board of Pharmacy	2 -4	Source	?	?
Wyoming	WY	ASAP 4.2	sFTP	Atlantic Associates, Inc. Phone: [phone]	2 - 4 + Tramadol, Carisoprodol	Source	Weekly	?

References

1. Islam MM, McRae IS (2014). "An inevitable wave of prescription drug monitoring programs in the context of prescription opioids: pros, cons and tensions". BMC Pharmacol Toxicol. 15 (46). doi:10.1186/2050-6511-15-46. PMID 25127880.
2. Sacco, Lisa N.; Duff, Johnathan H.; Sarata, Amanda K. (May 24, 2018). Prescription Drug Monitoring Programs (PDF). Washington, DC: Congressional Research Service. Retrieved 5 June 2018.
3. Rutkow, Lainie; Smith, Katherine C.; Lai, Alden Yuanhong; Vernick, Jon S.; Davis, Corey S.; Alexander, G. Caleb (2017). "Prescription drug monitoring program design and function: A qualitative analysis". Drug and Alcohol Dependence. 180: 395–400. doi:10.1016/j.drugalcdep.2017.08.040. PMID 28978492.
4. Rutkow L; Chang H; Daubresse M; et al. (2015). "EFfect of Florida's prescription drug monitoring program and pill mill laws on opioid prescribing and use". JAMA Internal Medicine. 175 (10): 1642–1649. doi:10.1001/jamainternmed.2015.3931. ISSN 2168-6106. PMID 26280092.
5. Pardo, Bryce (2017). "Do more robust prescription drug monitoring programs reduce prescription opioid overdose?". Addiction. 112 (10): 1773–1783. doi:10.1111/add.13741. PMID 28009931.
6. Department of Health. (n.d.). Retrieved from https://www.health.ny.gov/community/opioid_epidemic
7. Finley, Erin P.; Garcia, Ashley; Rosen, Kristen; McGeary, Don; Pugh, Mary Jo; Potter, Jennifer Sharpe (20 June 2017). "Evaluating the impact of prescription drug monitoring program implementation: a scoping review". BMC Health Services Research. 17 (1). doi:10.1186/s12913-017-2354-5. PMC 5477729. PMID 28633638.
8. Briefing on PDMP Effectiveness. (2014). In Prescription Drug Monitoring Program Center of Excellence At Brandeis (p. 13). Brandeis University .
9. Thielking, M., Ross, C., Branswell, H., Hogan, A., & Associated Press. (2017, March 7). Missouri is the only state not tracking prescription drug use. Here’s why. Retrieved January 24, 2019, from https://www.statnews.com/2017/03/07/missouri-prescription-drug-database/
10. "Integrating & Expanding Prescription Drug Monitoring Program Data: Lessons from Nine States" (PDF). National Center for Injury Prevention and Control. February 2017.
11. Fink, David S.; Schleimer, Julia P.; Sarvet, Aaron; Grover, Kiran K.; Delcher, Chris; Castillo-Carniglia, Alvaro; Kim, June H.; Rivera-Aguirre, Ariadne E.; Henry, Stephen G.; Martins, Silvia S.; Cerdá, Magdalena (8 May 2018). "Association Between Prescription Drug Monitoring Programs and Nonfatal and Fatal Drug Overdoses". Annals of Internal Medicine. 168 (11): 783. doi:10.7326/M17-3074. PMC 6015770. PMID 29801093.
12. Hwang, Catherine S.; Turner, Lydia W.; Kruszewski, Stefan P.; Kolodny, Andrew; Alexander, G. Caleb (2016). "Primary Care Physicians' Knowledge And Attitudes Regarding Prescription Opioid Abuse and Diversion". The Clinical Journal of Pain. 32 (4): 279–284. doi:10.1097/ajp.0000000000000268. PMID 26102320.
13. Pharmacist's Manual. (n.d.). Retrieved from https://www.deadiversion.usdoj.gov/pubs/manuals/pharm2/pharm_content.htm

Further reading

• Moyo, Patience; Simoni-Wastila, Linda; Griffin, Beth Ann; Onukwugha, Eberechukwu; Harrington, Donna; Alexander, G. Caleb; Palumbo, Francis (October 2017). "Impact of prescription drug monitoring programs (PDMPs) on opioid utilization among Medicare beneficiaries in 10 US States". Addiction. 112 (10): 1784–1796. doi:10.1111/add.13860. PMID 28498498.