Pennsylvania was one of the last states to implement a prescription drug monitoring program, but it has been critical in reducing doctor shopping, the state’s physician general said.
It was nearly impossible to track doctor shopping before Pennsylvania implemented a prescription drug monitoring program a year ago.
Doctor shopping is the practice of visiting multiple physicians to obtain multiple prescriptions for opioids or benzodiazepines, classes of drugs that would otherwise be illegal.
Pennsylvania was one of the last states to implement a prescription drug monitoring program, but it has been critical in reducing doctor shopping, Rachel Levine, M.D., Pennsylvania’s acting secretary of health and physician general, said at a news conference Aug. 31, which was International Overdose Day.
The number of people who visited five or more doctors or pharmacists to obtain a prescription dropped 86 percent in one year. And the number of people who went to 10 or more doctors or pharmacists has been eliminated entirely.
“Some people would go to one pharmacy and pay with their insurance, come to another pharmacy and pay cash and not use their insurance so they could get more than they were supposed to,” said pharmacist Rich Jay, of Frontier Pharmacy at 1216 W. Sixth St. “There’s not much you could have done before. The PDMP makes it a lot easier to make sure you’re looking out for the patient’s well-being.”
State law requires anyone who can prescribe or dispense Schedule II-V class drugs, including through the mail or online, to register with the system, query the database before prescribing such medications and, if they do so, report prescription information to the PDMP by the end of the next business day.
More than 93,000 prescribers and dispensers had registered with the PDMP after one year. Registering was voluntary for the first three months of the program, but became mandatory on Jan. 1.
Doctors, pharmacists and other registered health care professionals query Pennsylvania’s PDMP more than 53,000 times each weekday.
Levine, noting that at least 13 Pennsylvanians die from a drug overdose each day, said the PDMP is just one tool in fighting the scourge of the opioid epidemic.
“The goal of the prescription drug monitoring program is to assist health care providers in prescribing and dispensing medications safely and referring patients to treatment if needed,” Levine said. “Since its inception it has really developed into an invaluable tool.”
More than 80 percent of heroin addicts began by abusing prescription drugs, according to the state Department of Health.
The American Medical Association is one of several proponents of PDMPs. Nationwide, PDMPs helped cut opioid prescriptions by more than 43 million, or 17 percent, between 2012 and 2016. Opioid prescriptions dropped in every state over the five-year period. During a shorter period — 2014 to 2016 — the number of doctors and other health-care professionals registered with a state-based PDMP increased 180 percent and usage of these databases jumped 121 percent.
Levine called the system “robust.” However, she said more improvements will be made to it by the end of 2017. Pennsylvania, which shares data with 11 other states and Washington D.C. already, will add more states in coming months. Also, the PDMP will begin integrating electronic medical and pharmacy records.
Lauren Hughes, M.D., deputy secretary for health innovation, also said the state is working to accurately track authorized users to determine compliance.
Hughes and Levine said the system is not only used to prevent doctor shopping, but also to facilitate addiction treatment for anyone suspected of the practice.
Not everyone is convinced, however.
A group of researchers at Pennsylvania State University recently found that such programs have no appreciable impact on reducing overdose deaths, and in fact, might contribute to the problem.
Yunfeng Shi, assistant professor of health policy and administration at Penn State, said that the research was confined solely to mortality rates and did not include other factors, like the effectiveness of driving down misuse and inappropriate prescribing. It is likely, he said, that patients turn to illicit drugs or online pharmacies after being turned away by their doctors.
“You need to look at the combined evidence, and based on what I’ve learned, it does seem to be the case that the programs have some impact … on reducing misuse and inappropriate prescribing; that’s what the literature shows,” he said. “However, based on our studies, at the same time those programs do seem to have a negative or bad impact, or not much of an impact at all, on mortality rates.”
Matthew Rink can be reached at 870-1884 or by email. Follow him on Twitter at twitter.com/ETNrink.