Wednesday, June 1, 2011

Spotlight on Prescription Drug Abuse

Drug related poisonings are now the leading cause of death from unintentional injury in 16 states with the situation becoming more urgent since in recent years millions of Americans have reported the misuse of prescription drugs. This puts a significant financial strain on our nation’s healthcare system in the form of increased emergency room visits and medical complications.

On May 24, 2011, Senator Sheldon Whitehouse (D-RI) chaired a Senate Judiciary Subcommittee on Crime and Terrorism where experts in the field presented their thoughts on the topic “Prescription Drug Epidemic: Strategies for Reducing Abuse, Misuse, Diversion, and Fraud” .

Gil Kerlikowske, Director of the Office of the White House Drug Control Policy Office and Chief Advisor to the President on anti-drug efforts is in charge of producing the “National Drug Control Strategy”. His office not only directs the nation’s anti-drug efforts but also establishes programs, a budget, and produces the guidelines needed for cooperation among Federal, state, and local entities.

He made several suggestions to the Committee on how to respond appropriately to the problem:

• Prescriber education should be mandatory and parents need to be educated as to the dangers and prevalence of prescription drug abuse
• Each state needs to establish a Prescription Drug Monitoring Program (PDMP) to contain information on dispensed controlled substances prescribed by healthcare providers. PDMP would serve as a tool for patient care and provide early warnings when there is a drug epidemic
• Establish proper medication disposal programs so unused or expired medications are disposed in a responsible way
• Establish smart law enforcement to assist states in addressing “Pill Mills” and “Doctor Shopping”

John L. Eadie, MPA, Director, for the Prescription Monitoring Program at the Center of Excellence at the Brandeis University Heller School of Social Policy and Management, told the Committee that the Brandeis Center of Excellence is working very hard to end the prescription drug abuse epidemic in the U.S. without compromising accepted standards of pain management or the legitimate prescribing of controlled substances.

Eadie explained that the Brandeis Center of Excellence with grant funding from the Department of Justice, Bureau of Justice Assistance also works in collaboration with the “Alliance of States with Prescription Monitoring Programs” to find solutions to the vast prescription drug abuse problem facing our nation.

He told the Committee that the Center for Excellence has expressed great concern for the youth in this country and is working with Maine, South Carolina, and Wyoming PMPs to examine prescribing and “doctor shopping” patterns. The data indicates an increase in youth who are obtaining opioid prescriptions during and after high school. The data available from Wyoming shows that the peak of “doctor shopping” occurs between the ages of 30 and 39 with a very large number 29 and younger.

The Prescription Monitoring Programs (PMP) work by collecting valuable information from pharmacies, from prescribers, and from patients, regarding each controlled substance prescription dispensed individually.

The data compiled in each PMP’s database is made available to not only prescribers and pharmacies, but also to law enforcement officials, health professionals, licensing agencies, and depending on the state involved to Medicaid Programs, medical examiners, drug courts, drug treatment programs, and others. De-identified data is generally made available to researchers and evaluators and in some states patients may look at their own data.

Some PMPs proactively analyze their own databases and when they identify probable “doctor shoppers”, they send an unsolicited report to the prescribers. Experience indicates such reports result not only in reducing the subsequent prescriptions obtained by the “doctor shopper” but also in a significant increase in prescribers requesting solicited PMP data

Looking towards the future, Eadie told the Committee that in addition to federal funding support, the nation needs the PMPs to evolve into a new generation of even more effective systems. This new generation of systems needs to take advantage of technological advances and be integrated into the PMP operations.

Eadie emphasized that data included in the systems needs to be timely and the data needs to be available in a seamless manner. For example the Massachusetts PMP is moving to make their PMP interoperable with EHRs so prescribers can access the PMP from a single EHR sign-on.

He continued to say that a new National Network of state PMPs is needed to be interoperable through the Prescription Monitoring Information Exchange (PMIX) Hub which BJA, IJSI Institute, and the Alliance of States have been working to establish for the past six years. Progress is being made because today the HUB is operational and several states are in the process of interconnecting to the system.