Prescription Drug Monitoring Program
Prescription Drug Monitoring Program
Deaths in the U.S. due to prescription drug overdoses are reaching crisis proportions. The increase in the death rate due to all prescription drugs has been primarily due to the increase in prescription opioid pain medicine. State governments were looking for a solution to the problem, and instituted Prescription Drug Monitoring Programs (PDMP) which record who is receiving specific prescription medications at any pharmacy in the state. The information goes into a government database that can be accessed by physicians and pharmacists. Having access to this information would stop individuals from obtaining medication from multiple physicians commonly known as “doctor shopping.” It was assumed that doctor shopping was the only way to obtain large quantities of prescription medication for diversion. Despite the fact that every state, except one, has a PDMP, the death rate due to prescription medications continues to rise. If essentially every state has a PDMP and the death rate continues to rise, is this the correct solution?
Drugs that cause overdose deaths are primarily pain medicines (opioids), and to a lesser extent tranquilizers (benzodiazepines). A National Institute on Drug Abuse report shows the number of deaths caused by all prescription drugs for the entire country has increased from 7,885 in 2000 to 29,728 in 2015, and the number of deaths per 100,000 population, age adjusted, has increased from 2.81 in 2000 to 9.23 in 2015. That is a 277% increase over 16 years or 17% per year.
How did opioid pain medication become such a large problem? Before 1990, physicians were reluctant to prescribe opioid pain medication. It was only prescribed for a limited time for broken bones and after surgeries. Chronic use was limited to terminal cancer patients. During the 1990s, federal and state agencies started encouraging physicians to treat chronic pain with opioid pain medicine. Pain had become the fifth vital sign. Unfortunately, it was the only vital sign that did not have an objective measurement.
In 2000, 16 states had a PDMP. That number increased to 27 by 2005 and to 43 by 2010. In 2014, every state plus the District of Columbia had a Prescription Drug Monitoring Program, except Missouri. The graph shows the increase in prescription drug deaths and the number of PDMPs in the country. If the programs are effective, why do the numbers keep getting worse?
Prescription drug monitoring programs are found in forty-nine states and the District of Columbia. Missouri is the only state that does not participate. Since Missouri is the only state without a program, it should be at the top of the list of deaths by prescription drug overdoses if these programs actually work. The graph below shows the number of deaths in 2015 due to prescription drug overdoses, per 100,000 population, age adjusted, by state. Missouri (red arrow) is 22nd.
Proponents claim that a PDMP is required to catch all of the “doctor shopping” that makes opioid medications readily available to the public. Is doctor shopping really a problem? According to the 2015 National Survey on Drug Use and Health, obtaining pain relievers (opioids) from more than one doctor is minimal. The sample size of the 2015 survey was 68,073. The estimated number of persons age 12 and older who misused opioid pain medicine in 2015 was 12.4 million. That is 4.7% of the U.S. population in that age group. In this survey, the total percentage of users aged 12 and older who obtained pain relievers for misuse from more than one doctor was 2.3%. 85.8% got pain medicine from one doctor themselves, got it free from a friend or relative, or bought or took it from a friend or relative who obtained it themselves by one of these four methods. Since the survey started asking the question in 2011, the percentage from more than one doctor increased incrementally each year from 3.6% in 2011 to 4.8% in 2014. The decrease in 2015 was due to a change in the question asked in the survey from lifetime misuse to misuse in the past 12 months. Clearly, doctor shopping is not the massive problem the proponents of PDMPs would have us believe, and it increased each year from 2011 to 2014 despite 43+ states spending hundreds of millions of dollars to stop it. The real problem is the 97.7% which will not be caught by a PDMP.
PDMPs fail because they affect only 2.3% of all the individuals who misuse or divert prescription pain medication. The real problem is the other 97.7% which PDMPs will not catch. When one patient consistently gets the same pain medicine from one physician every month, that is not doctor shopping. There is no way for the physician or pharmacy to determine if that specific prescription is being diverted. The PDMP will show the same person filling the same prescription medication from the same physician month after month which is a normal pattern. The most common way for individuals to get medication is to get it from one doctor or from a friend or relative who got it from one doctor. PDMPs can not catch this method of diversion, because all of the medication comes from one physician.
Unlike insurance company and government run programs like Medicare, Medicaid, and the Veterans Administration prescription databases, the PDMP is an involuntary database. When you participate in Medicaid, you agree to your prescriptions becoming part of their database. That is not the case with the PDMP. It’s a mandatory, involuntary government database. Because it is involuntary, it violates Article I, Section 15 of the Missouri constitution. When all of the state databases are interconnected, it then becomes a de facto national database.
Overdose deaths by prescription opioid drugs is a large and growing problem in this country. Of the forty-nine states and the District of Columbia that have implemented a PDMP, none of them have shown a long term decrease in the death rate. Yet these failing programs continue to expand and enlarge their databases. The ultimate goal is not to fix a problem, but for centralized governmental bureaucracies to gain more control through the database.
CDC Wonder website. http://wonder.cdc.gov
Two of the charts in this paper were created from data obtained on the CDC Wonder website.
DEA (U.S. Drug Enforcement Administration). Drug Schedules.
National Institute on Drug Abuse. https://www.drugabuse.gov
Graphs on deaths due to prescription medication and illicit drugs.
Rose A. Rudd, MSPH; Noah Aleshire, JD; Jon E. Zibbell, PhD; R. Matthew Gladden, PhD. Increases in Drug and Opioid Overdose Deaths — United States, 2000–2014. Morbidity and Mortality Weekly Report (MMWR) January 1, 2016 / 64(50);1378-82.
Substance Abuse and Mental Health Services Administration. 2015 National Survey on Drug Use and Health: Detailed Tables (tables 6.47B, 6.48B, 6.51B, and 6.52B)