Sweep­ing opi­oid bill won’t re­quire docs to check data­base for abusers

Modern Healthcare - - NEWS - By Steven Ross John­son

Pa­tient ad­vo­cates say the opi­oid abuse bill Con­gress passed this month—even with­out the ad­di­tional fund­ing many wanted—will open doors for peo­ple seek­ing treat­ment by ef­fec­tively de­crim­i­nal­iz­ing ad­dic­tion.

But some of the same peo­ple say law­mak­ers blew an op­por­tu­nity to strengthen the coun­try’s abil­ity to track the opi­oid pre­scrip­tions that are fu­el­ing an epi­demic of over­dose deaths.

An older ver­sion of the Com­pre­hen­sive Ad­dic­tion and Re­cov­ery Act would have boosted grants for databases that flag overusers of pre­scrip­tion drugs—but only for states that re­quire physi­cians to check those databases be­fore writ­ing a pre­scrip­tion.

But physi­cians lob­bied against the re­quire­ment, ar­gu­ing that it was bur­den­some and that the databases, known as pre­scrip­tion drug mon­i­tor­ing pro­grams, of­ten failed to pro­vide the most up­dated and com­pre­hen­sive in­for­ma­tion.

The fi­nal bill pro­vides the grant money but elim­i­nated the re­quire­ment.

Gary Men­dell, founder and CEO of the na­tional anti-ad­dic­tion ad­vo­cacy or­ga­ni­za­tion Shat­ter­proof, said the omis­sion could have a po­ten­tially “tragic ef­fect for fam­i­lies across our coun­try.”

“With­out this in­cen­tive tied to fed­eral grants, leg­is­la­tion at the state level will be adopted slower than it would with grants con­di­tioned upon this re­quire­ment,” he said.

Pre­scrip­tion drug mon­i­tor­ing pro­grams, or PDMPs, were first es­tab­lished by states in the 1930s. The pro­grams now ex­ist in ev­ery state and the Dis­trict of Columbia with the ex­cep­tion of Mis­souri, where re­peated at­tempts in the Leg­is­la­ture have faced op­po­si­tion from pri­vacy rights groups.

The databases col­lect, mon­i­tor and an­a­lyze in­for­ma­tion from phar­ma­cies and pre­scribers to iden­tify whether a pa­tient is seek­ing mul­ti­ple pre­scrip- tions of a med­i­ca­tion such as an opi­oid, a prac­tice most com­monly known as “doc­tor shop­ping.”

The pro­grams also alert providers when a pa­tient has been pre­scribed other med­i­ca­tions that could be dan­ger­ous when mixed with an opi­oid. For ex­am­ple, stud­ies show mix­ing opi­oids with tran­quil­iz­ers in­creases the like­li­hood of an over­dose by four times.

Ev­i­dence sug­gests that providers who use the databases pre­scribe fewer opi­oids. A Health Affairs study in June found a 30% re­duc­tion in the rate of Sched­ule II opi­oid pre­scrib­ing from 2001 to 2010 among 24 states im­me­di­ately af­ter launch­ing a drug mon­i­tor­ing pro­gram.

But de­spite the ben­e­fits, the pro­grams re­main un­der­uti­lized. The me­dian rate of reg­is­tra­tion among pre­scribers was about 35%, ac­cord­ing to a 2012 re­port from the U.S. Jus­tice Depart­ment’s Bu­reau of Jus­tice As­sis­tance. A 2015 study in Health Affairs found 72% of physi­cians sur­veyed were aware of their state’s pro­grams, but only 53% used them.

Only 22 states re­quire pre­scribers to check the databases, and providers rarely do so be­fore pre­scrib­ing opi­oids in states where it is vol­un­tary—only 14% of the time ac­cord­ing to a 2015 re­view by Bran­deis Uni­ver­sity re­searchers. Even so, the med­i­cal com­mu­nity is di­vided over whether physi­cians should be com­pelled to use the PDMPs.

The Amer­i­can Med­i­cal As­so­ci­a­tion, how­ever, calls for the vol­un­tary use of state-based pre­scrip­tion drug mon­i­tor­ing pro­grams “when clin­i­cally ap­pro­pri­ate.”

But Bal­ti­more City Health Com­mis­sioner Dr. Leana Wen said the opi­oid over­dose epi­demic means “we need ev­ery tool in our tool­box, and re­quir­ing the use of PDMPs is an im­por­tant tool.”

Wen ac­knowl­edged that PDMPs could be eas­ier to use. They of­ten re­quire a provider to log into a dif­fer­ent sys­tem than an elec­tronic health record sys­tem. And not all state sys­tems share their data, mean­ing the

in­for­ma­tion can some­times be in­com­plete. Es­tab­lish­ing a na­tional data­base would ad­dress that is­sue, she said, and that should have been a pri­or­ity in the new leg­is­la­tion.

Calls to es­tab­lish a na­tional pre­scrip­tion drug mon­i­tor­ing data­base have grown louder in re­cent years be­cause of the drug abuse epi­demic. In 2014, more than 18,000 peo­ple died of over­doses of pre­scrip­tion opi­oid painkillers.

“We have this na­tional prob­lem, and in my mind we have the means for a na­tional so­lu­tion,” said Tom Biz­zaro, vice pres­i­dent of health pol­icy and in­dus­try re­la­tions for health data firm First Data­bank. “But we’re still de­pen­dent on th­ese in­di­vid­ual state pro­grams.”

Yet some ar­gue a na­tional data­base would ac­tu­ally be less suc­cess­ful than im­prov­ing cur­rent state pro­grams.

“The tech­nol­ogy is al­ready built in the states,” said Men­dell, the Shat­ter­proof founder who does not sup­port cre­at­ing a na­tional sys­tem. “Within two years ev­ery state in our na­tion can, with highly ef­fi­cient PDMPs, share data with all 50 states and, equally im­por­tant, have con­trol at the state level that fos­ters in­no­va­tion that would oth­er­wise be sti­fled.”

Ef­forts to strengthen the state pro­grams be­gan im­me­di­ately af­ter Con­gress passed the Com­pre­hen­sive Ad­dic­tion and Re­cov­ery Act. The same day, Sens. Amy Klobuchar (D-Minn.), Joe Manchin (D-W.Va.), and An­gus King (I-Maine) in­tro­duced a bill that says if states want the grants they must re­quire prac­ti­tion­ers to con­sult the databases.

The bill also would com­pel drug dis­pensers in states that re­ceive fed­eral fund­ing to re­port to their PDMP within 24 hours of pre­scrib­ing con­trolled sub­stances; re­quire states to no­tify pre­scribers when the PDMP shows signs of pa­tients mis­us­ing opi­oids; and re­quire states to make PDMP data avail­able to in­clude in an in­ter­state data-shar­ing sys­tem.

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