Episode Transcript
Aaron: Prescription drug monitoring, that's next on The Scope.
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Aaron: I'm here with Peter Kreiner PhD, he's a senior scientist at the Institute of Behavioral Health of the Schneider Institutes for Health Policy, a researcher for the Heller School for Social Policy and Management and he's an expert in prescription drug monitoring. Welcome Dr. Kreiner.
Dr. Kreiner: Thanks, Aaron.
Prescription Overdose Deaths
Aaron: Dr. Kreiner, here in Utah, deaths due to prescription overdose have been increasing since about 2001 and we have about 21 Utahans die from prescription overdose every month. Is this a nation wide problem?
Dr. Kreiner: It certainly is, Aaron. Probably from the early 2000's on, public health officials started recognizing opioid and prescription drug overdose death as a huge and increasing problem and recognition has just grown from there. So in the last few years, all federal agencies and national organizations, state governments have grown increasingly concerned with the problem and have started reaching out in a lot of different directions to look for solutions.
Aaron: Now what is a prescription drug monitoring program? I understand that's one of the solutions that they're looking at.
Prescription Monitoring Programs
Dr. Kreiner: Prescription monitoring programs are essentially a data repository. Forty-nine states have now passed legislation authorizing such a program. Forty-eight states have actual operating programs. The hold outs are Missouri for legislation and New Hampshire is just about to have an operating program. They're repositories of filled or dispensed prescriptions for controlled substances that pharmacies are required to submit to each state program. So they are databases that are intended to serve multiple stake holders, typically prescribers and pharmacists and often other individuals can establish an account with a prescription monitoring program and log in and query it about a patient to inform their clinical decision making.
In many states law enforcement can access the data in relation to an active case investigation and increasingly the value of this data is being recognized and so monitoring programs are providing data to other entities like medical examiners, drug courts, to follow some of their clients. Treatment facilities are accessing the data to see if patients in treatment facilities might be obtaining prescriptions that their clinicians don't know about. So there's a lot of innovation going on now across the country about use of this data
What Data Does a Monitoring Program Record?
Aaron: What sort of data is maintained by these monitoring programs?
Dr. Kreiner: It's a record of each prescription that's dispensed, includes information about the patient, the prescriber, and the pharmacy that dispensed it, including dates the prescription was written, the date it was dispensed and info about the specific drug prescribed, the dosage the, date of supply, often whether or not it was a refill or if refills are allowed. In many states it includes information about the payment source. So, kind of insurance, cash, that sort of thing.
Patient Safety
Aaron: What's the value of the program overall for patient safety?
Dr. Kreiner: For patient safety, again if a patient presents a prescriber or their physician, could be an emergency room or could be their primary care physician, that physician may or may not know about the prescription history of that patient. Often physicians think this is a legitimate patient, have legitimate symptoms. I'm interested in prescribing a pain medication opioid analgesics and yet when they check the monitoring program, they find that person may have obtained half a dozen prescriptions from a number of different prescribers in the last month. That's a very different picture of that patient then they might have had.
Aaron: So ultimately this can help a health care provider help a patient stop an addiction or at least get help for an addiction before it goes too far. Is that safe to say?
Dr. Kreiner: Patients may be obtaining multiple prescriptions for lots of different reasons. So they may be misusing or abusing, they may be addicted, they may be diverting. And certainly the prescriber, it's intended that they might have a discussion with that patient and really try to help that patient to seek appropriate help. It's an ongoing issue about what treatment resources are available and that's an issue in every state.
Aaron: Utah has a prescription drug monitoring program. I don't know how familiar you are with Utah's particular program, but based on what you've seen nation wide in your experience, how do you think Utah could better use its prescription drug monitoring program to prevent overdosing?
Dr. Kreiner: Our center, so we have a prescription drug monitoring program center of excellence at Brandeis University, studies best and promising innovative practices that monitoring programs are doing nation wide. So we've identified 30 some odd practices that keep increasing all the time. Some of the more impactful ones that we've seen in other states that I believe Utah is not currently implementing include what's called unsolicited reporting where a monitoring program proactively analyzes this data and pushes out a report or sometimes an electronic alert to a prescriber or pharmacist for a patient to bring that information to their attention.
Several states have enacted mandates for prescribers and or pharmacists to register with the program and query it under specified conditions. For example recently New York, Kentucky, Tennessee and even though those programs are quite recent, it's already had an impact on the amount of use of that program. But also in certain indicators of doctor pharmacy shopping and opioid prescribing.
Some other practices that seem very valuable that we've been using in Massachusetts is use of de-identified prescription monitoring program for public health surveillance purposes in particular to provide it to counties and communities, we're working to prevent and reduce prescription overdoses, prescription drug related problems. I could go on, but those are some leading practices that I think Utahans could benefit from.
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