Controlled Substances: Using a PDMP at the Point of Care
Decades ago, many opioid addictions began with hard narcotics, such as heroin, that were obtained illegally, but as we move deeper into the twentieth century, many opioid addictions begin with a well-intentioned prescription for pain. The truth is, if you are prescribed an opioid, you are at risk of addiction. They are powerful endorphin triggers, and our human bodies are complex machines. There is really no way to predict who will become dependent. According to National Institute on Drug Abuse (NIDA) Opioid-involved overdoses more than doubled between the years of 2010 to 2017. They continue to rise, with a reported 80,411 deaths in 2021. Prescribing these drugs responsibly is critically important to curb this crisis. We cannot ignore the negative consequences of opioids, and Prescription Drug Monitoring Systems are a powerful tool to help.
What is a Prescription Drug Monitoring Program?
A PDMP is an electronic database that tracks controlled substance prescriptions on a state level. Information from PDMPs can help prevent overdose, giving providers indications when a patient may be at risk. It can also help provide context on a patient’s medical history if they are new to a provider and don’t have documented medical history.
The information collected in these databases is used to calculate NARX Scores for a patient, which provides a weighted numerical score of a patient’s controlled substance usage based on factors like the number of prescribers or pharmacies a patient has, and the amount, strength, and duration of different medications a patient has taken. NARX Scores divide controlled substance usage into three categories: Narcotics, Sedatives, and Stimulants.
PDMPs also provide an Overdose Risk Score, which uses the same data as the NARX score to determine overall risk. While there is some correlation between these two scores, the way they interpret the data differs, offering another perspective on what the long-term use habits of a patient may mean.
A Brief History of PDMPs
Concerns over addictive substance abuse have existed in the US since the late nineteenth century and have intensified today. Abuse of medical opioids was evident during prohibition, and early forms of PDMPs were adopted in the early twentieth century. In places like New York, systems were built that required sending duplicate prescriptions to state agencies or using special prescription paper for controlled substances to track how many narcotics a certain doctor was sending. As tracking evolved, doctors could query these systems, but its primary purpose was for law enforcement to track narcotics usage.
The “California Triplicate Prescription Program,” developed in 1939, used state-issued prescription forms for controlled substances to be completed in duplicate so the pharmacist could send a record to the state database via mail. This formed the basis of the modern PDMP system. Over the next 50 years, only a handful of other states would join California in creating prescription tracking systems for narcotics. But continued concerns of addiction and widespread internet adoption in the 1990s opened the door and led most other states to enact their own drug monitoring programs. Throughout the ’90s and 2000s, there was a jump from 16 to 43 online PDMP systems across states.
With the shift to the internet, providers can now directly query a given PDMP to retrieve information about a patient’s narcotics history. They are no longer just a tool for law enforcement but also part of the process of responsibly prescribing medications for pain management. While not a perfect system for risk, they can be a useful tool at the prescribing level for mitigating the effects of and preventing narcotics abuse. When using the DoseSpot platform, we can directly link providers to the PDMP of the state they are prescribing in through 1-click API integration.
Providing Context of Patient Behavior and Prescription History Through PDMPs
PDMP and NARX Scores aren’t meant to supersede a provider’s medical expertise. They simply provide context and help inform providers of potential abuse or doctor-shopping behavior from the patient. Studies have found that PDMPs reduce the distribution of opioids and opioid overdose deaths by about 12%.
PDMPs at the Point of Care
When included as part of a risk/benefits system for prescribing opioids, PDMPs and NARX scores can help providers intervene with at-risk patients. The CDC recommends that providers check the state PDMP when initiating opioid therapy for a patient and frequently throughout continued opioid therapy treatments. Information from PDMP data should not be the only deciding factor in a treatment decision for a patient. No data is free of bias, and each individual patient’s unique circumstances must be considered when making a care decision.
Does your state have a PDMP?
Currently, PDMPs are maintained in all 50 US States, the District of Columbia, and three US territories (Guam, Northern Mariana Islands, and Puerto Rico). Requirements for use vary by state, with some requiring PDMPs to be checked as part of the screening for prescribing a controlled substance, while others function entirely voluntarily. For specific information on a state’s PDMP requirements and practices, you should look for their PDMP information page on the specific state website.
With ePrescribing controlled substances, comes a moral obligation to do the right thing. Providers are taking oaths to “Do no harm.” Whether it is required or not, checking your state’s PDMP database when recommending a patient start an opioid therapy will help set that patient up for success. With such an accessible tool, providers should always do what they can to ePrescribe responsibly.