Prescription Drug Monitoring Programs: Promising Practices to Maximize Their Effectiveness Peter Kreiner, Ph.D. Prescription Monitoring Program Center of Excellence at Brandeis University NGA Meeting September 27, 2011
Number of PDMPs Statutorily Authorized PDMPs, 1939-2011 60 50 49 PMPs 40 30 20 10 0 Years
A (very) brief note about the PMP Training and Technical Assistance Center and PMP Center of Excellence Oct., 2008 grant from BJA to Alliance of State PMPs and Brandeis University for national PMP TTAC www.pmpalliance.org Has hosted 3 national PMP meetings, 8 regional meetings, 3 topical meetings (including law enforcement use of PDMP data) PMP Center of Excellence (COE) added in Feb., 2010 www.pmpexcellence.org Responsible for identifying best practices in selected areas, and assisting PDMPs in implementing them
PDMPs represent a vastly under-utilized resource. PDMP data can be used to increase the effectiveness of: Clinical practice Prescriber and dispenser online access to PDMP data on their patients Interstate sharing of PDMP data (KY OH, others) Unsolicited reporting (evidence mixed see our WY Notes from the Field) Prescriber education (appropriate opioid prescribing, how to incorporate PDMP data into clinical decision-making) Substance abuse treatment (see Keeping Patients Safe: Using PDMP Data in an Outpatient Addictions Treatment Setting Notes from the Field, in your binder)
PDMPs represent a vastly under-utilized resource. PDMP data can be used to increase the effectiveness of: Medical Examiner reports (VA future Notes from the Field) Drug Courts (KY Notes from the Field) Medicaid Fraud units (SD enables Medicaid Fraud unit access by law) Alternatives to incarceration (see Staying Clear of the Law and Addiction: Nevada s Pre-Criminal Intervention Program Notes from the Field, in your binder) Prevention Community profiles Targeting of take-back programs
PDMPs represent a vastly under-utilized resource. PDMP data can be used to increase the effectiveness of: Law Enforcement and Regulatory Boards Doctor shopping investigations Reliably identify plausible suspicion of doctor shopping Increase efficiency of investigation by identifying pharmacies and prescribers from which to request records Increase reach of investigation by identifying more remote pharmacies and prescribers used Overall impact of use of PDMP data: enable identification and investigation of more cases, and make more evidence available, increasing likelihood of successful prosecution
PDMPs represent a vastly under-utilized resource. PDMP data can be used to increase the effectiveness of: Law Enforcement and Regulatory Boards Investigations of dishonest prescribers PDMPs can screen data for unusual amounts and types of controlled substances prescribed by a single practitioner E.g., holy trinity of hydrocodone, Xanax, Soma Large geographic separation between patients and prescriber E.g., Oxy Express from FL to KY E.g., prescriptions written in GA and filled in AL
Average Number of Patients per GA Prescriber for Prescriptions Filled in AL in 2009, by GA Zip Code Legend Average number of patients per prescriber 0.00-5.22 5.23-18.50 18.51-46.83 46.84-148.00 148.01-437.50
Average Number of Prescriptions per Patient, 2009 Prescriptions Originating in GA and Filled in AL, by GA Zip Code Legend Average number of prescriptions per patient 0.00 0.01-1.88 1.89-3.33 3.34-6.00 6.01-10.20
GA Zip Codes with More Than 100 Patients per Prescriber and More Than Two Prescriptions per Patient, on Average, for Prescriptions Filled in AL in 2009 Legend GA Zip Codes meeting (1) or not meeting (0) the criteria 0 1
PDMPs represent a vastly under-utilized resource. PDMP data can be used to increase the effectiveness of: Law Enforcement and Regulatory Boards Investigations of dishonest pharmacies Unusual patterns of dispensing and of patient location Pharmacy under-reporting of controlled substances dispensed (e.g., to conceal some sales) Can be identified by comparing prescriber and pharmacy records, a process greatly facilitated by electronic prescribing of controlled substances Also by comparing net quantities of controlled substances delivered to a pharmacy and net quantities reportedly dispensed Recently enacted policy in NY
Evidence of effectiveness of law enforcement use of PDMP data Perceived effectiveness in preventing/reducing diversion > 90% of law enforcement respondents in KY saw PDMP as effective Time saved in investigations Anecdotal evidence Suggestive findings about lower death rates in selected states which provide unsolicited reports to law enforcement
Next steps PDMP interstate data sharing Identify cases of diversion that do not meet single-state thresholds Identify geographic patterns of diversion/abuse over a wider area Timeliness of PDMP data OK has now implemented real-time reporting TTAC, COE will work with OK to assist other states in moving toward Investigator online access to PDMP data In process of being implemented in MA Law enforcement education: value and use of PDMP data TTAC developing training for law enforcement
Contact Information PMP Training and Technical Assistance Center www.pmpalliance.org PMP Center of Excellence of Brandeis University 781-736-3909 www.pmpexcellence.org Peter Kreiner, Ph.D., Principal Investigator, COE pkreiner@brandeis.edu Phone: 781-736-3945 14