What is the PDMP? 

PDMP stands for Prescription Drug Monitoring Program. PDMPs collect, monitor and analyze prescribing and dispensing data submitted by pharmacies and practitioners dispensing controlled drugs from their offices. The idea behind it was to help in states’ efforts to educate, research, enforce, and prevent drug abuse.  Have they succeeded? Let’s evaluate where this has taken us.

PDMP’s were first developed in the early 2000’s. Not required at first, practitioners could choose to query them on their patients.  The development of the PDMP was not intended to interfere with appropriate medical use.  One of the statements on the PDMP website is

                “PDMPs do not infringe on the legitimate prescribing of a controlled substance by a practitioner acting in good faith and in the course of a professional practice.”

Now of course, the practitioner’s understanding of “good faith” and “in the course of professional practice” has been totally destroyed by the Justice System in their quest to rob practitioners of their assets. See Ron Chapman’s evaluation on good faith HERE.

How is the PDMP supposed to be used?

Prescription data is supposed to only be provided to entities authorized by state law to access the program.  When started, that included only the health care practitioners and pharmacists pertaining to active patients, and regulatory boards when needed.  Law enforcement could only access specific data with a warrant based on just cause. But that is no longer the case.

Law enforcement agencies now have complete access to the PDMP data to simply do screening data searches.  Private companies are now involved in the monetary benefits of supplying law enforcement with data analytics that allow these searches to be accomplished quickly and easily to target practitioners that could then be easily convicted in court. These companies, such as Appriss and Qlarant brag about their connections with government agencies to make convictions “easy”.

The NABP (National Association of Boards of Pharmacy) PMP InterConnect facilitates the transfer of PDMP data across state lines, which is supposed to provide a more effective means of combating drug diversion and drug abuse nationwide. The PMP InterConnect involves all states except California, Nebraska, and Missouri.

However, as offshoots of the PDMP, there are now

• PDMP Enhancements
  • Prescriber Report Cards
  • Options for Unsolicited Reporting
• PDMP Evaluations
  • Tracking PDMP Enhancement: The Best Practices Checklist
  • Implementing Best Practices
  • An Assessment of the Evidence for Best Practices
• Training Guides
  • Practitioner Education
  • Training Law Enforcement

Prescribers currently get alerts now when the patient’s aggregate prescription level exceeds certain thresholds, such as:

• Prescription of more than 100 mme per day.
• Prescription of more than 40 mme of methadone daily.
• Prescriptions continuing longer than 90 days.
• Prescriptions of both opioids and benzodiazepines.
• Prescriptions from 6 or more prescribers in the last 6 months.
• Prescriptions from 6 or more pharmacies in the last 6 months.

The intended result of these alerts is for the clinician to talk with the patient. Attempt to determine the reasons for the concerning behavior which could include:

• Changing providers
• Under-treatment of pain
• Misunderstanding the doctor’s pain management rules
• Prescription drug abuse
• Illegal behavior—diversion, fraud, etc.

As a result, the clinician should express concern over these behavior patterns, discuss risks of misuse, clarify expectations, and possibly increase patient monitoring and limit-setting. And all of this needs to be documented in the patient’s chart. Always remember: Not documented—not done!

How do they plan to judge the effectiveness of the PDMP?

By measuring the following:

1. Increase in the number of healthcare professionals using the PDMP
2. Reduction in the reported rate of non-medical users of prescription drugs
3. Reduction in the initiation rate of non-medical users of prescription drugs
4. Reduction in the rate of prescription drug abuse
5. Reduction in the rate of ER admissions for prescription drug overdose
6. Reduction in the rate of prescription drug-related deaths.

Evaluation

PDMPs have now been used for almost 20 years. It should be time for a judgement as to their effectiveness. Using the measurements listed above, in spite of all practitioners now being required to participate in the PDMP data acquisition, that is the only measurement that has been positive. The other 5 measurements are abject failures. The only success in the use of the PDMP is the targetting of practitioners prescribing controlled substances.

Conclusion

Tracking prescription use and trying to control drug misuse by limiting prescriptions and attacking practitioners for their prescribing is a total failure.  Less prescriptions are being written, and yet there is more misuse, abuse, and overdose in the population.  We need to stop focusing on legitimate doctors writing legitimate prescriptions for legitimate patients and learn the REAL cause of drug abuse if we ever intend to bring the drug abuse/overdose down.