Implementing prescription drug monitoring programs
Prescription drug monitoring programs allow prescribers to perform a statewide search to determine when a patient last had a controlled substance prescribed.
According to the Pennsylvania Department of Health, 80% of heroin abusers started their drug abuse with prescription medications.1 In order to combat this problem, Pennsylvania recently became the 49th state to implement a drug monitoring program. With the start of this program, Pennsylvania prescribers are now able to perform a statewide search to determine when a patient last had a controlled substance prescribed. My coworkers and I have long awaited this day, and we feel that this database will be a crucial tool towards the fight against narcotic abuse. As soon as the program was launched, we noticed immediate effects.
Since the program started, whenever a patient requests pain medication or is suspected of malingering, we are able to search their name and determine whether they have had a recent prescription written for a controlled substance. We can also see who wrote the prescription and the pharmacy where it was filled. We are also able to print out these records and present them to the patient, which is very useful when we encounter patients who have drug seeking tendencies.
I thought that the majority of patients would argue with us when we presented them with their prescription records, but I was pleasantly surprised that most patients quietly accept it. In addition, when patients request pain medication and I inform them that they can take the medicine they were recently prescribed, most of them agree and do not request more. We still encounter patients who try to argue with us, or try to say that they lost their medicine or that it was stolen, but these are far and few between compared to the majority of patients I have encountered.
The system, of course, is not without fault. The state requires that the prescriber search the database the first time they prescribe a controlled substance to a patient. In the emergency department, this can become very cumbersome. The system tends to log out after a very short period of time and during a very busy day, taking time to re-log in and look up the patient in the database can be very time consuming. In addition, for patients who require obvious narcotic prescriptions, such as a patient with a compound fracture, being required to look up a patient in the database to research their history can seem like a moot point. I really enjoy having the ability to look up patients who I think may be drug seeking, but being required to look up every patient can be taxing .
The database also only allows us to search for prescriptions in Pennsylvania. Unfortunately, we live on the border of New Jersey and it is possible that patients can continue to get prescriptions filled in both states, and our search of the database becomes grossly inaccurate. My hope is that the state-wide databases will come together in the near future so that we will be able to search for patients on a nationwide database.
Overall, I think that the launch of the database is very beneficial as it aids the fight against narcotic abuse. Patients are generally accepting of the information when we present them with their prescription history, and this is something I was pleasantly surprised with. The fact that we are required to search for patients can become time consuming and is not very beneficial when patients present with injuries that warrant narcotic medication. However, if this is what is required in order to have the ability to research all patients, then I will happily do it. While the state-wide database is very useful, I fear it is not the most accurate representation of a patient's prescription history. A national database would be most beneficial and I hope we develop one in the near future. I think it would be a critical tool in the fight against the narcotic epidemic.
Jillian Knowles, MMS, PA-C is an emergency medicine physician assistant in the Philadelphia area.
- Pennsylvania Department of Health. Prescription Drug Monitoring Program: Information for Prescribers. Accessed October 28, 2016.