Drug overdose death rates in the United States have more than tripled since 1990, outnumbering car accidents as the leading cause of accidental death in the country. This epidemic has spurred nearly every state to create a Prescription Drug Monitoring Program (PDMP). In 2001, just 16 states had established a PDMP to address the problem of prescription drug abuse. Today, a PDMP exists in 49 of the 50 states.
Despite the programs' pervasive presence, it’s not clear if they work. For example, even a 2012 report out of Brandeis University’s Prescription Drug Monitoring Program Center of Excellence is itself conflicted.
“Evidence suggests PDMPs are effective,” it says, and one paragraph later counters, “questions have been raised about the effectiveness of PDMPs.”
The key to effectiveness is often technology—or lack thereof. As Governing previously reported, doctors typically have difficulty getting their hands on the information they need in a timely and efficient manner. Kate Tipping, a policy analyst with the Office of the National Coordinator (ONC) for Health Information Technology, said, “Forty-nine states have monitoring programs in place, but most of their providers and pharmacies are not accessing them regularly because it doesn’t fit in with their workflow.”
The ONC has backed pilot projects in Indiana and Ohio to “explore ways we could help get that information to providers in real-time and see if it can be used to determine if a controlled substance should be prescribed,” she said.
California is tackling the problem as well. Last month, Gov. Jerry Brown signed bills to create better IT tools and beef up the state's PDMP database known as CURES, which was essentially left to rot during California's recent fiscal struggle.
On the other coast, New York state recently revamped its PDMP and upgraded its IT capabilities with a new program it calls I-STOP, short for the Internet System for Tracking Over-Prescribing Act.
New York has made prescription drug data available to physicians since 2010, “but the old system was underutilized,” according to Terence O’Leary, director of the Bureau of Narcotic Enforcement for the New York State Department of Health (DOH). “In fairness to the practitioners, it wasn’t the most user-friendly system.” But the state now requires the DOH to update the program to make additional data available and to get it in the right hands more efficiently.
“It’s much quicker in returning data,” O’Leary says. “We’ve reduced the number of clicks needed to get to the data.” The report is more complete, he says, and includes all of the controlled substances prescribed by each doctor. “That lets them know if someone has stolen their number to self-prescribe."
The law also allows more people, like properly trained front-office staff, to access the system. “Doctors can designate others to do the search and audit the searches later,” he says. It's up to the doctor how many people have access. “Some designate a lot, some just one, it’s entirely up to them."
Another new feature of New York's PDMP is that pharmacists now have access to the data as well. “They may see something that the doctor doesn’t see,” he says. “Pharmacists have been clamoring for access to this data.”
I-STOP includes other additional functions, such as a link to a list of substance abuse treatment providers, so physicians can more easily find help for addicted patients. And planned upgrades include integrating the interface with electronic health records to automatically “push” PDMP data to the provider.
So far, the response has been encouraging. Between June 12 and Aug. 27, about 12,000 people used the system, whereas only 5,000 had accessed it over the prior three and a half years, O’Leary says. Through mid-September, 36,000 users had made a total of 1.2 million searches.
“The feedback has been overwhelmingly positive. They find it very user-friendly and the majority of searches take less than one second,” he says.
Will it help in a meaningful way? For now, the DOH is benchmarking utilization more than health outcomes. “We see an increase in users of about 5 percent every week, which is encouraging,” O’Leary says. Down the road, data will measure things like prescribing rates, addiction treatment rates and overdose death rates. “That will give us good evidence whether or not this is working."