Mandated Prescription Drug Monitoring Programs Should be a Priority
After three years of meetings, coalitions, hearings and intense advocacy, the Comprehensive Addiction and Recovery Act (CARA) was signed into law on Friday, July 22 by President Obama. We should be proud of the shift in conversation from criminal justice solutions for immoral, weak people to solutions focused on a chronic disease model that requires access to prevention services, intervention strategies, evidence-based treatment modalities and lifelong support.
As comprehensive as CARA is, no bill or law will ever be the entire solution to a health issue that has historically been ignored. Yes, we should celebrate this important step, and we should also recognize the work that remains.
A previous version of CARA included state grants to run and improve prescription drug monitoring programs (PDMPs) in states where prescribers and pharmacies were required to use them. Authorization for the grants is still there, but the requirement is not.
PDMPs collect data on controlled substances and are an effective intervention tool to identify those who “doctor shop” to obtain more prescription medications. A study published in June in Health Affairs found a 30% reduction in the rate of Schedule II opioid prescribing from 2001 to 2010 among 24 states after launching a drug monitoring program. But, this important tool is still underused. A 2015 study in Health Affairs found 72% of physicians were aware of their state’s programs, but only 53% used them.
Currently, PDMPs are operational in 37 states[i], but only 22 mandate their use[ii]. Without a mandatory requirement, prescribers are less likely to use PDMPs. A March report by Shatterproof found that in states where use was voluntary, prescribers used PDMPs only 14% of the time prior to prescribing an opioid.
Congress has not given up. Within hours after CARA passed, Sens. Amy Klobuchar (D-MN), Joe Manchin (D-WV) and Angus King (I-ME) introduced a bill that would require drug dispensers in states that receive federal funding to report to their PDMP within 24 hours after prescribing controlled substances. The legislation also requires states to make PDMP data available to an intrastate data-sharing system and to notify prescribers when the PDMP recognizes signs of opioid misuse. Practitioners would also be required to consult a PDMP prior to prescribing opioids.
While this is a nationwide problem, it requires more than a federal response. The National Governor’s Association released a Compact to Fight Opioid Addiction which includes mandating the use of PDMPs. Forty-three state governors and three territorial governors have signed on to the plan.
At the end of the day, this is not about restricting access to opioids for people who need them. PDMPs allow prescribers to make informed decisions. Our immediate next step as stakeholders in this crisis: making a strong, user-friendly and mandated PDMP a priority in every state and territory. It’s an easy case to make, but it’s up to us to make it.