MMS President: State Can Do Better On Prescription Drug Checks

By Lynda Young
President, Massachusetts Medical Society

The Massachusetts Senate’s recent unanimous passage of a bill to expand the state’s Prescription Monitoring Program is well intentioned, addresses a serious and growing problem, but, like The Boston Globe editorial of February 8 that speaks to the issue, falls short of addressing the heart of the matter.

Since 1992 when the PMP was established (with Massachusetts Medical Society support), the Department of Public Health has electronically recorded every prescription for Schedule II drugs, and since 2010, every Schedule III through V as well.  DPH has had regulatory and statutory mandates to review those prescriptions to find doctor shoppers and prescribers who overprescribe.

Its efforts, however, have fallen short, as no meaningful data, such as cross referencing Schedule II prescriptions with overdoses in the PMP database, has been compiled.  Prescribers are already registered with the DPH, yet are not given automatic access to the database, so additional registration by physicians would only seem redundant.  Further, prescribers are not notified of doctor shoppers among their patients with any frequency, another action that could reasonably be taken with an electronic system and an accurate read of the database.

An electronic database is a strong tool in the fight against prescription drug abuse, but the data must be accurate and timely. Real-time information, instead of that from the current lag of 10 days in pharmacies reporting to the DPH, is better.

Let’s also recognize that a major source of the prescription drugs being abused come from outside the state – a fact reported by the Cape Cod Times – and confirmed by law enforcement – in an eye-opening three-part series, “Pills that kill,” published in September of 2010.

We’re  keenly aware that “doctor shopping” is part of the problem, and that means that doctors can be part of the solution.  As prescribers, we are willing and eager to help. But it is not, as The Boston Globe suggests, “inconvenience”and “technophobia” that prevent us from enthusiastically backing the proposed legislation.

Before the state adds more administrative and costly steps, and before we take those steps that may risk delaying and denying appropriate care to patients who require it, let’s recognize that we have an adequate system in place. We should use it to its fullest capacity.

New: Read Dr. Young’s  Commentary on CommonWealthMagazine.org

This post was updated on February 15, 2012.

  1. Dr. Chantal Nouvellon says:

    Hi
    I agree that not all patients should be looked up: I am a child and adolescent psychiatrist and i can’t see any children being checked when they are not coming to the office for a pain treatment.
    This is such a waste of physicians time again. How are we suppose to do our job with so many useless requirements.

    Pharmacist should be updating their database so that would be enough.

    Thank you for your feedback

    Dr. Nouvellon

  2. John Patrick MD says:

    Dr. Young,

    Appreciated your response to the Globe on the subject. I fully agree that lots more could be done using the data currently collected that might be of much more value than the proposed legislation. (Email alerts to prescribers that an individual has filled multiple controlled prescriptions, containing an alert to check website with a case # or equivalent so privacy issues of names in email don’t have to be dealt with, etc.)

    In case it is of value in making the case to legislators who clearly have not though of the implications for the ED physician (the law as written requires checking the database for the 1st encounter with a patient), for whom most encounters are “first” encounters, here is a letter I also sent with data from the ED and Walk In Center where I work:

    Although the prescription monitoring bill referenced in the Globe’s Feb. 8 editorial is admirable in its intent, the devil is sometimes in the details. The bill would require physicians to access the State’s website to check for evidence of inappropriate drug seeking behavior by patients “prior to the issuance of a prescription for a narcotic drug.”

    As an emergency physician, I have long been an advocate for the availability of such a database, and was very happy to be one of the first to sign up for and use it when it began last year; I would encourage all physicians who prescribe opiates to participate in the program.

    However, a blanket directive to do so in ALL cases, instead of leaving the decision up to the judgment of the prescribing physician, is likely misguided.

    At the hospital where I work, I examined how often this rule might apply. For the 961 patients visiting the emergency department and urgent care center in a 1 week period, 125 had a narcotic prescription written. Assuming 2 minutes each spent to check the database, that’s over 4 hours of physician time per week engaged in what is likely in the great majority of cases to be a fruitless quest – time which might be better utilized caring for sick patients who already spend more time than they would like in the emergency department.

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