Databases may harm, not help

Prescription drug monitoring programs (PDMPs) are incredibly useful patient safety tools. What health care provider (whether a pathologist or a pediatrician) would not benefit from knowing what controlled substances his patients are taking? However, I am concerned that mandating that clinicians check these databases before prescribing opioid pain relievers would restrict, rather than improve, patient care.

In my state, Washington, it takes three passwords and then about three minutes from login to data output to check just one patient’s medication history. This is a problem for a busy clinician seeing 20 patients a day, and the cost of doing the right thing may be too much.

Thankfully some states (including mine) are working hard to provide easy and almost immediate access to prescription data. Unfortunately, it is not clear that these are the same states that mandate checks before prescribing opioids.

If the law prohibits prescribing opioids until a clinician checks the database, and access is long and laborious, it is not rocket science to hypothesize that opioid prescribing will decrease.

Indeed, opioid prescribing decreased 78% among dentists in New York after a mandate went into effect. Some will say this is fine. But if the decisions were made to avoid checks, rather than to improve care, then it is not fine with me.

If anything is to be mandated, I’d require that states (and medical facilities) improve PDMP user interfaces so the systems would be easier and faster to use.

I’d also favor requiring that physicians register with their state monitoring systems when they get their licenses. This would improve knowledge about the databases and increase use as clinicians learned about their value to patient safety. A statewide survey in Oregon found that nearly half the prescribers who didn’t use Oregon’s system didn’t even know that they could register.

Simply mandating that clinicians use prescription drug monitoring programs before prescribing opioids might not increase use and could instead harm patients.