Mis­souri opi­oid Rx-mon­i­tor­ing fight ig­nites de­bate over na­tional pro­gram

Modern Healthcare - - NEWS - By Steven Ross John­son

For years, there’s been de­bate over bal­anc­ing the need to track po­ten­tially ad­dicted pa­tients by pro­vid­ing their clin­i­cians with a vast amount of data on their pre­scrip­tion drug habits and main­tain­ing the pri­vacy of those pa­tients’ records.

The num­ber of over­doses caused by opi­oids makes the case for main­tain­ing ro­bust drug-mon­i­tor­ing data­bases, some ex­perts say.

Now the on­go­ing fight to track opi­oid pre­scrip­tions in the hold­out state of Mis­souri has once again raised dis­cus­sion on whether the coun­try would be best served by a na­tional mon­i­tor­ing sys­tem—or whether it’s too late to im­ple­ment that idea be­cause the drugs caus­ing over­doses are bought on the street.

Mis­souri is the only state in the na­tion with­out a pre­scrip­tion-drug-mon­i­tor­ing pro­gram, which col­lects in­for­ma­tion to warn physi­cians that they may over­pre­scribe opi­oids and pre­vent a pa­tient from seek­ing pre­scrip­tions from mul­ti­ple physi­cians.

Repub­li­can Mis­souri state Sen. Rob Schaaf, a fam­ily physi­cian and a long­time op­po­nent of drug-mon­i­tor­ing pro­grams, re­cently in­tro­duced a bill that would al­low a physi­cian to view a pa­tient’s med­i­cal data only when the state’s Depart­ment of Health and Se­nior Ser­vices iden­ti­fied cases of doc­tor-shop­ping. Crit­ics say a mon­i­tor­ing pro­gram just gives physi­cians more work, while oth­ers say it will just track the wrong ad­dic­tions since drug use has shifted.

Sup­port­ers con­tend a na­tional pro­gram ex­pands and stream­lines the in­for­ma­tion avail­able.

“I think that there wouldn’t be any­one who would dis­agree with the idea that it would be bet­ter to have a sin­gle na­tional sys­tem rather than all of these dif­fer­ent state sys­tems,” said Dr. An­drew Kolodny, codi­rec­tor of opi­oid pol­icy re­search at Bran­deis Univer­sity.

Kolodny said a uni­form na­tional sys­tem would solve the prob­lem of states be­ing un­able to track in­ter­state drug traf­fick­ing.

State pre­scrip­tion drug-mon­i­tor­ing pro­grams, or PDMPs, of­ten dif­fer in the tech­nol­ogy they use, as well as the rules and reg­u­la­tions by which they op­er­ate. Also, state PDMPs dif­fer on the fre­quency in which data is col­lected.

But the move to­ward es­tab­lish­ing a na­tional mon­i­tor­ing pro­gram has never taken off be­cause crit­ics feel states may lose the flex­i­bil­ity they need to ad­dress their spe­cific drug prob­lems.

“Each of these pro­grams, in do­ing some­thing dif­fer­ent, they also do a lot of in­no­va­tive things,” said Peter Kreiner, a se­nior sci­en­tist at the Sch­nei­der In­sti­tute for Health Pol­icy at Bran­deis Univer­sity. “If you had a na­tional pro­gram you could imag­ine the kind of bu­reau­cracy that would be as­so­ci­ated with that, and it’s un­likely it would be able to in­no­vate in nearly the way state pro­grams can.”

But ac­cord­ing to Tom Biz­zaro, vice pres­i­dent of health pol­icy and in­dus­try re­la­tions for health data firm First Data­bank and a long­time sup­porter of a na­tional drug-mon­i­tor­ing net­work, states would be able to keep their in­di­vid­ual reg­u­la­tions and rules un­der a na­tional net­work by ap­ply­ing stan­dards that are al­ready used by phar­ma­cies for claims re­im­burse­ment and elec­tronic pre­scrib­ing.

“The in­fra­struc­ture is there,” Biz­zaro said. “So we’re not talk­ing about hav­ing to cre­ate a pipe­line for that in­for­ma­tion; that al­ready ex­ists.” Us­ing that in­fra­struc­ture al­lows for states to de­ter­mine who has ac­cess to their PDMP, the kind of in­for­ma­tion that is shared, and what types of drugs would be in­cluded.

A to­tal of 41 states en­gage in some form of in­ter­state data-shar­ing. But most shar­ing is still done on a re­gional ba­sis. A physi­cian in Cal­i­for­nia may be able to eas­ily find that a pa­tient was pre­scribed opi­oids in Ore­gon, but they would not have a clue as to whether the same pa­tient re­cently re­ceived a pre­scrip­tion for pain re­liev­ers in New York or Illi­nois.

Sup­port­ers of a na­tional PDMP net­work be­lieve it would make in­ter­state data-shar­ing eas­ier. But it could also at­tract hack­ers.

“The big­ger a data­base gets the more prac­ti­cal con­cerns there can be about

data se­cu­rity and the ram­i­fi­ca­tions of hack­ing,” said Nathan Freed Wessler, a staff at­tor­ney with the Amer­i­can Civil Lib­er­ties Union’s Speech, Pri­vacy and Tech­nol­ogy Project. “There may well be ben­e­fits in terms of ef­fi­ciency, but in this area, I don’t think the ef­fi­ciency is the most im­por­tant value.”

Still oth­ers feel the whole premise of a na­tional PDMP may be out­dated con­sid­er­ing cur­rent trends in drug use. The rate of over­dose deaths by pre­scrip­tion pain re­liev­ers has been lev­el­ing off over the past few years, while deaths from heroin have sky­rock­eted from 8% of all drug over­dose deaths in 2010 to 25% by 2015, ac­cord­ing to the Cen­ters for Dis­ease Con­trol and Prevention.

“The drug prob­lem keeps chang­ing, keeps mor­ph­ing, and keeps stay­ing ahead of the ef­forts to ad­dress it,” Kreiner said. “Hav­ing a slow-mov­ing en­tity that’s try­ing to help ad­dress it is prob­a­bly not a great idea.”

In­creas­ing scru­tiny of opi­oid pre­scrib­ing prac­tices in the past few years has helped to re­duce pre­scrip­tions. That may have led ad­dicts to switch to heroin as pre­scrip­tion med­i­ca­tions be­come sparser.

“It seems like the ship may have al­ready sailed on that,” said Bryce Pardo, a drug pol­icy an­a­lyst with re­search and con­sult­ing pub­lic pol­icy firm BOTEC Anal­y­sis Corp., re­fer­ring to the data­base help­ing curb the over­dose epi­demic. “It seems like the mar­ket is shift­ing to­ward heroin, so it seems like we’re en­ter­ing the sec­ond stage of this epi­demic.”

But Kolodny said the CDC fig­ures do not pro­vide an ac­cu­rate por­trait of what is truly hap­pen­ing in terms of the epi­demic. He said the switch from pain re­liev­ers to heroin oc­curred early in the drug epi­demic, pre­dom­i­nantly among younger adults, but pre­scrip­tion opi­oids re­main a large con­cern among older Amer­i­cans.

Biz­zaro be­lieves there will some­day be a na­tional drug-mon­i­tor­ing pro­gram and he’s gaug­ing the Trump ad­min­is­tra­tion’s in­ter­est in de­vel­op­ing one.

“I think it just makes too much sense to have a na­tional pro­gram,” Biz­zaro said. “I see it now as more of a po­lit­i­cal is­sue than a tech­ni­cal one.”

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.