INTRODUCTION:

A PDMP is a state wide electronic database which tracks all controlled substance prescriptions. Legal users can access prescription data such as medications dispensed and doses. Improving the way opioids are prescribed will ensure patients have access to safer and much more effective chronic pain treatment while reducing opioid misuse, abuse, and overdose. Checking your state’s PDMP is an important step in safer prescribing of these drugs. [1] A PDMP is a tool which can be used to address prescription drug diversion and abuse. PDMPs serve number of functions which includes: -patient care tool; drug epidemic early warning system; and drug diversion and insurance fraud investigative tool. These tools help prescribers to avoid drug interactions and identify drug‐seeking behaviours or “doctor shopping.” PDMPs can also be used by professional licensing boards to identify clinicians with patterns of unsuitable prescribing and dispensing, and to assist law enforcement in cases of controlled substance diversion. [2]

OBJECTIVES:

The main study objective is to conduct a systematic literature on PDMPs. Specific research questions were defined as PICO questions.

1: How the PDMPs impacted opioid-related clinical outcomes and other related tools? 2: How has the incorporation of PDMPs into EHRs impacted utilization and usability?

HISTORICAL BACKGROUND:

Opioid abuse has become an increasing issue in the US. Since 1999, overdose deaths and prescription drug sales have quadrupled. There were over 63,000 deaths happen due to drug overdoses in the US in 2016.The age adjusted drug overdose rate has been increased from 6.1 per 100,000 to 19.8 per 100,000 from 1999 to 2016. National and state guidelines have been implemented to help providers make more informed decisions when prescribing these medications. Prescription drug monitoring programs (PDMPs) is being implemented in whole the country as a decision support for prescribers, pharmacists and regulators. PDMPs are electronic databases that collect and analyse patient prescription data [3].

Providers, like prescribers and pharmacists, are required to check the PDMP before they prescribe controlled substances such as amphetamines, benzodiazepines, and opioids. Prescribers and Pharmacists may be alerted by a PDMP message if a patient is at risk of substance abuse. Most algorithms quantify use based on the morphine milligram equivalent (MME), it is a value assigned to opioids to represent their relative potencies. Controlled substances are divided by Schedules I through V. Schedule I drugs are substances with the help of highest abuse potential, therefore never prescribed by a provider. An example of a Schedule I opioid is heroin. Schedule II, III, IV, and V drugs are commonly prescribed by providers. Of these, Schedule II substances have the highest potential for physical dependence. Schedule II drugs include the branded opioids, Vicodin and Percocet. Schedule III, IV, and V drugs are considered to have very low physical dependence potential. Each state has a requirement for providers to check the PDMP before prescribing and/or dispensing certain scheduled drugs, but these requirements vary from state to state. [4]

METHODS:

Literature search:

First step is assessing the evidence base for practice effectiveness, we conducted a systematic review of the medical (PubMed), psychological (PsycINFO), and economics literature through November 2011 for articles pertaining to the effectiveness of PDMPs and PDMP best practices, using a Predetermined set of search terms. Search terms included prescription drug monitoring, prescription monitoring, doctor shopping, multiple prescribers, unsolicited reporting, and proactive reporting. All articles from peer--‐reviewed journals, published in English, were considered for inclusion. Abstracts identified through searches were reviewed to clarify the publication’s relevance, and eligible articles were retrieved and read to further verify the study’s applicability. These searches were Expanded by reviewing the references cited in relevant articles. Articles were excluded if the data did not include outcome measures that would allow us to report on the effectiveness of PDMPs or of the best practice examined. In later drafts of this white paper, the literature search was extended to May 2012

Data extraction and categorization of evidence

Researchers extracted data on study characteristics from the articles and other sources of evidence identified, and summarized the combined evidence for each potential best practice in descriptive and tabular formats. The tabular summary of evidence drew upon and was adapted from guidance provided by several sources on grading scientific strength of evidence (i.e., Lohr, 2004; Owens et al., 2010) The criteria outlined by these authors include a hierarchical evaluation of the study design, the risk of bias, the quantity of the evidence (such as the number of studies), the directness of the evidence, the consistency of the evidence, and the precision and magnitude of the estimates. Due to the paucity of studies found on PDMP best practices, we focused our analysis on summarizing the type and level of evidence available, the number of research studies, and where applicable, key findings and consistency of the research evidence. Type of evidence was categorized into two major classes: published or Prescription Drug Monitoring Programs: An Assessment of the Evidence for Best Practices formally documented studies or consensus statements, and informal, anecdotally reported experience from the field and stakeholder perceptions in support of particular practices. The first category includes randomized controlled trials (RCTs) or meta--‐analyses of RCTs; quasi--‐experimental designs (e.g., observational studies with Comparison groups); other observational studies without comparison groups (e.g., interrupted time series) and case studies; and written guidelines describing a consensus of expert opinion, such as the Alliance of States with Prescription Monitoring Programs’ PMP Model Act (ASPMP, 2010). The grading system for this category ranks RCTs as the strongest evidence and expert opinion as the weakest. The consistency of the evidence for any given practice refers to the extent to which reported research findings from two or more studies show the same direction of effect. The second informal category of evidence consists of accumulated field experience with practices adopted by some states that suggests their efficacy, and the sometimes-convergent perceptions among PDMP administrators and stakeholders (e.g., PDMP end users and advisory boards, legislative committees, and policy experts) concerning the value of a practice, whether proposed or in use. In some cases, these experiences and perceptions may be plausible indicators of possible best practices that will need formal research and evaluation to be adequately assessed. We recognize that since the field is rapidly evolving, additional Studies on PDMPs will likely have been published and new applications of PDMP data implemented between the time of our literature search and the publication of this white paper. This speaks to the need for continued monitoring of the “moving target” that is PDMP research and practice, to which this paper aims to contribute. [5]

Fig: Aspects of PDMP

Risk Management Advice:

Legal and Professional Obligations:

Familiarize yourself with the PMP in your state and its requirements, if any, for prescribers. Licensing boards and professional organizations are useful resources for this information. The Alliance of States with Prescription Monitoring Programs is also a good for general information.

Inform your patients:

Some states, like Virginia, require that prescribers have to provide notice to their patients that they will access PMP data. You may want to do this even it is not required to by the state as part of educating and informing your patients. Remember, however, that you do not need patient authorization to access the PMP. Moreover, you should not seek patient authorization to access the PMP as doing so may lead patients to believe they can prevent you from reviewing it when they cannot.

Proper Prescribing and Monitoring of Medications:

Consider whether applying for accessing to and using the data might assist you in taking decisions on prescribing controlled substances. Incorporating review of the data in your practice may particularly needful when seeing new patients who request prescriptions for controlled substances. Having the data may also make it easier to start a conversation with your patients on proper use of controlled substances, the risks of misuse and diversion, and the availability of substance misuse programs. We know that allegations of improper prescribing and monitoring of medications form the basis for a useful majority of lawsuits filed against our insured psychiatrists. Use of PMP data minimize the risks of the allegations being made against you with regard to controlled substances and may indicate at the time of a treatment relationship needs to be ended. [6]

Impact and promise of PDMPs:

Evidence from national studies suggest that when PDMP data is readily accessible to physicians it contributes to reductions in medically inappropriate prescribing and patient doctor-shopping

· A national evaluation comparing states with and without PDMPs found that the presence of a state PDMP reduced supply and abuse of prescription medicines.

· A national analysis found state PDMPs were associated with lower rates of use of schedule II opioids, but suggested that a need for improved use of the information contained in these databases to bolster effectiveness.

· A national study found an association between PDMPs and mitigated opioid abuse and misuse trends over time.

· The Brandeis University PDMP Centre of Excellence, which monitors PDMP implementation throughout the country, has found numerous state-based surveys linking utilization of these programs to reduced doctor shopping. [7]

REFERENCES:

1. U.S. Department of Health and Human Services, “Prescription Drug Monitoring Programs (PDMPs).” pp. 1–3, 2013.

2. D. DE Baehren DF, Marco, CA, “Fact Sheet: Prescription Drug Monitoring Programs,” Off. Natl. Drug Control Policy, US, no. April, pp. 1–4, 2011, [Online]. Available: https://www.ncjrs.gov/pdffiles1/ondcp/pdmp.pdf.

3. P. W. Aditya Ponnapalli, Adela Grando, “Systematic Literature Review of Prescription Drug Monitoring Programs.” pp. 1478–1487, 2018.

4. J. S. P. Erin P Finley, Ashley Garcia, Kristen Rosen, Don McGeary, Mary Jo Pugh, “Evaluating the impact of prescription drug monitoring program implementation: a scoping review.” p. 420, 2017, [Online]. Available: 10.1186/s12913-017-2354-5.

5. T. Clark, J. Eadie, and P. Knue, “Prescription drug monitoring programs: an assessment of the evidence for best practices,” … Drug Monit. Progr., p. 95, 2012, [Online]. Available: https://www.ncjrs.gov/App/Publications/abstract.aspx?ID=265339.

6. C. Implications, “Prescription Drug Monitoring Programs: What You Need To Know in 2014,” Med. Prof. Liabil. Insur. Psychiatr., no. 2, pp. 2013–2015, 2014.

7. T. E. H. Authors: Valerie Fleishman, “Physicians and PDMPs:,” Netw. Excell. Heal. Innov. One, no. November, pp. 1–11, 2015.

Received on 01.12.2020 Modified on 07.08.2021

Research J. Science and Tech. 2021; 13(4):265-268.

DOI: 10.52711/2349-2988.2021.00042

Someshwar D. Mankar*, Abhijit S. Navale, Suraj R. Kadam