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prescription monitoring program (PDMP)

Indications: - created to diminish prescription drug abuse & diversion - an alert physicians if patients are getting controlled substances from another provider Notes: - state-run systems that gather information on controlled substance prescriptions from pharmacies & prescribers - allows prescribers to view patient' controlled substance history & monitor controlled substance use - information is useful for documenting adherence & for early detection of possible abuse* - 30% overall decrease in prescribing rates for Schedule II opioids [3] - uncertain value in preventing opioid overdose deaths [5] - need to register online - prescriptions that are filled but never picked up will show up in the system - nearly 2/3 of patients with opioid dependence without opioid precriptions logged into the system in the prior 12 months [4] - no demonstrated benefit for mandatory prescription drug monitoring with elective surgery [6] - it does not document - treatment with methadone at an opioid treatment program - arrest for selling drugs - a diagnosis of substance abuse - reason(s) for seeking a new prescriber - healthcare encounters for drug overdose(s) * this is only true if system works as intended & patient obtains all opiates through a prescriber that commits to the prescription monitoring program * it does not determine whether the patient is actually taking the medications or is transferring them to another individual * as such, this a hugely short-sighted program, useful for what it does do, but far short of reasonable effort * regular urine drug screens should be used to determine that the patient is actually taking an opiate, but this in itself is also inadequate

General

monitoring

References

  1. Prescriber's Letter 17(7): 2010 Prescription Drug Monitoring Programs Detail-Document#: 260701 (subscription needed) http://www.prescribersletter.com
  2. Medical Knowledge Self Assessment Program (MKSAP) 17, 18. American College of Physicians, Philadelphia 2015, 2018.
  3. Bao Y, Pan Y, Taylor A et al. Prescription drug monitoring programs are associated with sustained reductions in opioid prescribing by physicians. Health Aff (Millwood) 2016 Jun 1; 35:1045 PMID: 27269021
  4. Hawk K, D'Onofrio G, Fiellin DA et al. Past-year prescription drug monitoring program opioid prescriptions and self-reported opioid use in an emergency department population with opioid use disorder. Acad Emerg Med 2017 Nov 22 PMID: 29165853 http://onlinelibrary.wiley.com/doi/10.1111/acem.13352/abstract
  5. Fink DS, Schleimer JP, Sarvet A et al. Association between prescription drug monitoring programs and nonfatal and fatal drug overdoses: A systematic review. Ann Intern Med 2018 May 8; PMID: 29801093 http://annals.org/aim/article-abstract/2680723/association-between-prescription-drug-monitoring-programs-nonfatal-fatal-drug-overdoses - Compton WM, Wargo EM. Prescription drug monitoring programs: Promising practices in need of refinement. Ann Intern Med 2018 May 8 PMID: 29801101 http://annals.org/aim/article-abstract/2680724/prescription-drug-monitoring-programs-promising-practices-need-refinement
  6. Stucke RS, Kelly JL, Mathis KA et al Association of the Use of a Mandatory Prescription Drug Monitoring Program With Prescribing Practices for Patients Undergoing Elective Surgery JAMA Surg. Published online August 22, 2018 PMID: 30140927 https://jamanetwork.com/journals/jamasurgery/fullarticle/269662