More than 3,500 people died last year from drug overdoses in Pennsylvania (one of the highest overdose rates in the nation). In response, Pennsylvania is taking action to address this crisis of opioid use and abuse, including the launch of a Prescription Drug Monitoring Program (PDMP), PMP AWARxE, a timely and critically important tool.
How we got to this point
Not that long ago, well-meaning people strongly advocated that pain assessment and treatment be integrated into all patient care. The idea was simple and noble – better pain treatment would decrease suffering and improve patient outcomes.
Unfortunately, many providers did not understand just how complex the pain experience is, and that not all pain can be effectively treated with opioids. Opioid use dramatically expanded, even when other pain treatments would have been safer and more effective. The increase in opioid use was likely accelerated by aggressive marketing by pharmaceutical firms, which saw soaring profits from the use of branded opioids.
Over the years we discovered that opioids for noncancer pain have limited impact on pain control, and even more limited impact on physical or mental functioning. Indeed, the average pain relief when opioids are used on a chronic basis is 40% or less. While opioids can provide important pain relief, they don't work in every patient, and many patients experience serious side effects. Chronic opioids are associated with several side effects that can lead to serious harm or death, in addition to the well-known risk of misuse and addiction (which can also lead to overdose and death).
Pennsylvania takes action
Advocacy by several organizations that started in 2010 led to the introduction in 2011 of legislation to create a prescription drug monitoring program, (PDMP), by Representative Gene DiGirolomo (R-Bensalem) and 39 original co-sponsors. An interdisciplinary task force chaired by Pennsylvania's Secretary of Drug and Alcohol Programs, Gary Tennis, and now led by the Physician General, Dr. Rachel Levine, supported this effort, as well as the creation of several state-based guidelines about the use of opioids and other controlled substances in medical practice. This unique partnership includes numerous representatives of interested organizations and the community, and has led to real action that will make a difference.
Until recently, Pennsylvania was one of a handful of states that did not have a functioning PDMP. The legislation to create one passed in the fall of 2014, and the PDMP went live on August 25, 2016.
The value of a prescription drug monitoring program
A PDMP is an electronic database of controlled substances dispensed in the state. It can be accessed by prescribers, state policymakers, and law enforcement. The goal is to help prescribers avoid improper prescribing, while allowing for proper prescribing to patients with a legitimate medical need for controlled substances. Data from PDMPs can be used by state agencies to identify both patients and providers who engage in risky or illegal behavior. From a physician's perspective, a PDMP can provide important information that simply cannot be obtained in any other manner. This information can be used to guide clinical decision-making, thus improving patient outcomes. A recent study found that states implementing a PDMP reduced their rate of prescribing Schedule II opioids by 30%.
For information from a PDMP to be useful, it has to be accurate, timely, and easily available. The database also needs to be secure, as it contains private information. Of course, available data will be of no value if health care providers do not use the database. Most providers wish they had more time to take care of patients, and may not welcome yet another mandated, time-consuming task during the course of patient care. Physicians need to understand the PDMP's value in guiding clinical decision-making, as well as their obligations under this new state law.
State government and health care systems must work together on technology that allows for seamless transfer of PDMP data to the electronic health record, thus integrating this information into the process of patient care. Doing so will allow health care systems to better document and monitor the dose of controlled substances that is actually taken by the patient. This integration is possible but not easy, and likely will require the state to allocate additional resources to the PDMP.
While the launch of the Pennsylvania PDMP is a major step forward, a PDMP will not solve the prescription drug crises we are experiencing in Pennsylvania. Indeed, concern has been raised that Pennsylvania might experience a growth in IV heroin use as prescription drugs become less available for nonmedical use. Other initiatives are underway, including provider education based on the state clinical practice guidelines, innovative changes to the process of pain care to lower inappropriate use of opioids, and improved screening, referral and treatment for addiction. We now have a generation of individuals who face an addiction crisis, and they deserve compassionate, appropriate care for this life-threatening disorder.
Michael Ashburn, MD is a Professor in the Department of Anesthesiology and Critical Care at the University of Pennsylvania, and a Senior Fellow of the Leonard Davis Institute of Health Economics. Dr. Ashburn has been active in supporting the development of the PDMP, and is on the Pennsylvania PDMP Advisory Committee.
Editor's note: A version of this blog post appeared on the HealthPolicy$ense blog of the Leonard Davis Institute of Health Economics of the University of Pennsylvania.
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