Drug Topics - March 10, 2008 - (Page 46) 46 DRUG TOPICS MARCH 10, 2008 www.drugtopics.com Government and Law Prescription monitoring programs are coming to a state near you Martin Sipkoff he Office of Diversion Control of the Drug Enforcement Administration reports that as of December 2007, 35 states have legislation creating prescription monitoring programs (PMPs)—26 are operating and nine are in the start-up phase. Fourteen more states are considering such legislation. In mid-2005, there were 21 PMPs. Pharmacists and physicians are making use of these programs. The Alabama program, which began allowing medical professionals access to the PMP database in August (15 months after the program started), reported that more than Pain management 30,000 inquiries have been made to its database specialist Chris of 20 million scripts. Herndon believes These programs can be valuable, said Chris pharmacists can make clinical use Herndon, Pharm.D., a pain management speof PMPs. cialist and a member of the advisory board of the Alliance of State Pain Initiatives (ASPI), at the University of Wisconsin. “They can reduce the potential liability of pharmacists and physicians in filling and prescribing these drugs,” he said, by providing access to information about patient drug use patterns. “If the information is available for improved clinical care, not just for regulatory scrutiny, pharmacists should support its use.” That’s true, said Carmen Catizone, executive director of the National Association of Boards of Pharmacy. “But too often pharmacists are placed in the position of policing physicians and patients,” he said. “State boards do not want these programs to put pressure on pharmacists to be watchdogs.” According to an examination of legislation creating electronic PMPs conducted by Simeone Associates Ltd., a research organization in Albany, N.Y., the programs fall into two categories: • Reactive PMPs that generate solicited reports only in response to a specific inquiry made by a prescriber, dispenser, or other party with appropriate authority. • Proactive PMPs that identify and investigate cases, generating unsolicited reports whenever suspicious behavior is detected. States with proactive PMPs tend to be law enforcement oriented. Although PMP legislation does not directly mandate that pharmacists report suspicious prescribing patterns, the proliferation of such programs increases the likelihood it will do so, said Catizone. According to ASPI, PMPs are proliferating due to increases in prescription diversion. “ASPI does not oppose PMP programs per se,” according to a January 2008 statement. “(But) it believes that states should only adopt programs that are balanced and address all sources of diversion, while not interfering with the use of controlled substances for legitimate purposes.” To that end, the ASPI statement calls on state legislatures to ensure that programs are “administered by a state agency responsible for regulating health care rather than by the agency responsible for enforcing the laws of the state.” The 2005 National All Schedules Prescription Electronic Reporting Act authorized a system of federally funded, interoperative, state-based States with prescription prescription drug monitoring programs. The law monitoring programs focused on the creation of electronic prescription ccording to the Drug Enforcement Administration, 35 states either databases as public health intervention tools, but have prescription monitoring programs running or are in the process no funding was provided. of starting such programs. These states are Congress did, however, fund a Department of Alabama Iowa New Mexico Tennessee Justice program that emphasized the law enforceArizona Kentucky New York Texas ment aspects of prescription drug diversion and California Louisiana North Carolina Utah abuse, and states have been using those funds to Colorado Maine North Dakota Vermont create PMPs. According to some pain manageConnecticut Massachusetts Ohio Virginia ment professionals, that has meant that PMPs Hawaii Michigan Oklahoma Washington have been geared towards law enforcement, not Idaho Minnesota Pennsylvania West Virginia public health intervention. Illinois Mississippi Rhode Island Wyoming Whether they are designed to promote public Indiana Nevada South Carolina health or prevent drug diversion, PMPs are comFourteen more states are considering legislation to create a PMP: Alaska, ing to a state near you. Arkansas, Delaware, Florida, Georgia, Kansas, Maryland, Missouri, Montana, T A Nebraska, New Jersey, New Hampshire, Oregon, and South Dakota. THE AUTHOR is a writer based in Gettysburg, Pa. http://www.drugtopics.com
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