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Database tools battle opioid crisis

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The opioid epidemic in workers compensation has placed a spotlight on prescription drug monitoring programs, which aim to track the prescribing and dispensing of controlled substances and prevent abusive tactics such as doctor hopping and pharmacy shopping.

PDMPs are unique in that they can compile all controlled substance prescriptions, regardless of which pharmacy dispensed the prescription, who is issued the prescription or the source of payment, experts say.

“They collect data from pharmacies, usually in a day or at most a week, and prescription databases allow prescribers and other users to see what patients have been prescribed in terms of controlled substances ... They are very comprehensive databases that allow us to track and allow prescribers to see what their patients have been prescribed over the last few months and this is important because prescribers often don’t know what other prescribers have been giving their patients,” said Thomas Clark, Waltham, Massachusetts-based clearinghouse manager and senior research associate at The Prescription Drug Monitoring Program and Technical Assistance Center at Brandeis University.

In the United States, 49 states currently have operational PDMPs and last month Missouri Gov. Eric Greitens signed an executive order directing the Missouri Department of Health and Senior Services to create a prescription drug monitoring program. Prior to the executive order, Missouri was the only state that did not have a PDMP.

But a key challenge to creating a nationwide network of databases is that there is a lot of variation in each state’s regulatory language, said Dr. Dan Hunt, Lansing, Michigan-based corporate medical director at AF Group.

“Some states like Michigan allow more than just providers to have access, and in other states it’s just the providers (physicians, nurse and practitioners),” he said.

AF Group’s pharmacy team relies on access to PDMPs in helping injured workers — access that is available to them due to Michigan offering access to third-party carriers, he said. Tennessee and Arizona have similar regulatory language, he said.

Different studies have found a correlation between PDMPs and a decrease in the number of prescriptions or opioid-related deaths. A 2017 study by Cambridge, Massachusetts-based Workers Compensation Research Institute found a possible association between an increase in PDMP use and a reduction in frequency of opioid use among injured workers, but WCRI said it cannot claim causality or that these decreases were based solely on PDMPs.

A 2016 study published by health policy journal Health Affairs that looked at data on the year of legislative enactment and year of implementation found that a state’s implementation of a PDMP was associated with an average reduction of 1.12 opioid-related overdose deaths per 100,000 population in the year after implementation.

Another 2016 study published by Health Affairs found that a decrease in the number of prescriptions for Schedule II opioids, which have a high potential for abuse, was associated with PDMPs.

PDMPs are just one of many measures that have produced these results, according to experts.

Joe Paduda, Skaneateles, New Yorkbased president of CompPharma L.L.C., said 14 of the 15 people he has surveyed to date for his company’s 14th annual survey of prescription drug management in comp have seen a significant decline in opioids year after year.

“You can’t attribute that to PDMPs, to formularies, to more diligent utilization review etc., so it would be hard to parse out what the impact of PDMPs were,” he said. “I think PDMPs are one of a number of factors driving opioid utilization down.” 

Despite most states having PDMPs in place, participation by prescribers is low.

According to a 2016 report by New Yorkbased nonprofit organization Shatterproof, which is focused on addiction issues, only 14% of prescribers request patient information from their state PDMP prior to considering issuing a prescription for an opioid.

There is also a disconnect between states when it comes to information sharing. The National Association of Boards of Pharmacy’s PMP InterConnect attempts to link state PDMPs to share information.

Currently, there are 43 states working with InterConnect.

“There is a large focus on scalability as well as interoperability or interconnectedness ... as more states create technically proficient platforms to store data and allow it to be accessed, used, reported etc. … The next step beyond that is to share data across state lines,” said Mark Pew, Duluth, Georgia-based senior vice president of product development at Prium.

Mandated use of PDMPs could make a difference, according to experts.

“That transparency where prescribers can see doctor hopping, pharmacy shopping, day supply etc., the doctors who are treating work comp patients are also going to be able to see that because they are mandated to access it,” Mr. Pew said. “That likely will change prescribing behavior. It has changed prescribing behavior in Florida, Tennessee, New York, Kentucky and all these states that have mandated the use of respective prescription drug monitoring programs. They have shown when they have mandated use, prescribing behavior changed.” 

States that have a robust program along with PDMPs will see the most improvement, experts say.

“Robust means they have different formularies in place, they are asking providers to check their PDMPs, and they have prohibited prescribers from dispensing opioids without checking a PDMP,” said Reema Hammoud, Detroit-based director of clinical pharmacy at Sedgwick Claims Management Services Inc. “Different states have different rules in place, but the point is if a state has a really robust program, they have a little bit higher decrease in opioids compared to other states that just have a PDMP.”