On Rx Drug Monitoring, States Take Doctors' Recommendations

‘Clunky.” “Difficult to use.” “Not worth the effort.” These are the common complaints leveled over the years at prescription drug monitoring programs. PDMPs are state-maintained electronic databases that doctors, pharmacists and other health-care professionals use to keep tabs on their patients’ prescription drug habits. They’re considered vital in efforts to curb the opioid epidemic that has ravaged so much of the country. A physician can see, for instance, if a patient has been “doctor shopping” to get unneeded prescriptions. “This is probably the best tool we have to find out whether a patient is in crisis, and it also helps us identify doctors that are just prescribing too many pills,” says James Gessner, president of the Massachusetts Medical Society. 

It’s a tool, though, that doctors love to hate. A common gripe is that it takes more than 20 mouse clicks to see a patient’s prescription information. Doctors also complain that databases take up to a week or longer to update. But a movement to make PDMPs more functional has picked up considerable steam. Several states have recently upgraded their systems while also adding features to give doctors a more comprehensive look at a patient.

Massachusetts Gov. Charlie Baker campaigned, in part, on a promise to revamp his state’s PDMP. Easier-to-use technology was rolled out last August, along with a new law requiring doctors to check before prescribing the most addictive opioids. Around 70 percent of doctors signed up for the revamped database in its first six months, a marked increase from the number who had previously been using the system. In New York state, doctors are not only mandated to use electronic prescriptions but are also required to first look up a patient’s drug history.

Missouri is the only state without a PDMP, largely the result of a campaign by state Sen. Rob Schaaf, a physician who objects to the databases on privacy grounds. The state’s inaction has led several Missouri counties, including its most populous ones, to take matters into their own hands.

St. Louis, St. Charles and Jackson counties all authorized PDMPs in 2016, and the systems are set to go live later this year. Other counties will be able to access the data.

“This has really put a new wind in our sail,” says state Rep. Holly Rehder, who grew up among addicts in her family and whose daughter was once hooked on prescription opiates.

This month, Rehder withdrew a bill to create a statewide PDMP because the amended version would have threatened existing county systems.

No one in Missouri or elsewhere sees PDMPs as a silver bullet. While the number of prescriptions for opioids dipped nationally last year, overdose deaths ticked up to 50,000, driven in part by an increase in abuse of the synthetic opioid fentanyl. “The numbers that we’ve been seeing with fentanyl in particular are disappointing,” says Massachusetts’ Gessner. “This is an issue we’re going to be dealing with for a while.”

*This story has been updated from the version in the print magazine to reflect legislative developments.

*CORRECTION: A previous version of this story reported that Rep. Rehder withdrew her bill because of amendments from Rep. Schaaf. In fact, it was an amendment from a different legislator.