Researchers find variance in controlled substance prescription monitoring programs aimed at reducing overdose deaths
June 18, 2014
A new study finds that controlled substance prescription monitoring programs (PMPs) aimed at reducing drug overdose deaths vary tremendously by state and across time.
The researchers, all with connections to UNC Gillings School of Global Public Health, found that while every state requires that prescriptions for controlled substances must be reported to PMPs, this information is not always shared with professionals who could use it to prevent overdose deaths. Conversely, in some states law enforcement agencies have unfettered access to these databases, raising serious questions about privacy.
Nabarun Dasgupta, PhD, 2013 Gillings School alumnus, now with the School’s Injury Prevention Research Center (IPRC), along with lead author Corey S. Davis, JD, who received his Master of Science in Public Health from the Gillings School in 2010 and is with the Southeastern Region of the Network for Public Health Law, and Matthew Pierce JD, MPH, who previously worked at UNC’s IPRC and now is with the Health Law and Justice Program at the American University Washington College of Law, examined state statutes explicitly regulating PMPs.
Their study, “Evolution and Convergence of State Laws Governing Controlled Substance Prescription Monitoring Programs, 1998-2011,” was published June 12 in the online issue of the American Journal of Public Health. (PDF)
PMPs are state-level databases that collect patient-specific prescription information on controlled substances. Leaders in the White House Office of National Drug Control Policy and the Centers for Disease Control and Prevention have suggested that PMPs be used as a tool to reduce prescription drug overdose fatalities, which have seen a nearly six-fold increase in the last three decades and have become the country’s leading cause of injury death. Data are generated and transmitted to a central repository where, in most states, such authorities as medical professionals, regulatory bodies and law enforcement agencies may access them.
In theory, PMPs could address some of the causes of prescription opioid overdoses by providing patient-specific data on controlled substance prescriptions to prescribers, dispensers and regulatory agencies. However, the specifics of these programs vary greatly, making it difficult to determine whether they are effective in reducing overdose deaths. The study found that as of 2011, only 10 states required PMPs to report suspicious activity to law enforcement, and only three required reporting to the patient’s physician.
Of importance is the study’s finding that most PMPs emphasize criminal justice system referrals, and not a single PMP required the programs to link to drug treatment professionals. As of 2011, only five states required prescribers to access the PMP, a number that has increased since then. As of 2011, about two-thirds of states required that prescription data be reported to the PMP in one week or less; however, nine states permitted transaction data to be as much as a month old before being reported. The lack of real-time reporting is cited as one of the greatest impediments to fulfilling the promise of these tools.
The study concludes that while PMPs can be an important element in overdose prevention, a marked reduction in opioid overdose mortality requires a multifaceted approach that includes both law enforcement and public health. The authors also suggest that PMP records be timely, complete, and easily and consistently used by medical professionals and licensing agencies to be effective.
The research, supported by the Robert Wood Johnson Foundation’s Public Health Law Research Program, is available to the public at www.lawatlas.org.