All prescribers of opioids are now enrolled in the state’s Prescription Drug Monitoring Program; more work to be done

ACCORDING to the R.I. Department of Health, all health care providers authorized to prescribe opioids and other potent pain medications are now enrolled in the state's Prescription Drug Monitoring Program.
ACCORDING to the R.I. Department of Health, all health care providers authorized to prescribe opioids and other potent pain medications are now enrolled in the state's Prescription Drug Monitoring Program.

PROVIDENCE – It wasn’t an easy reach, but the R.I. Department of Health recently reported that all health care providers authorized to prescribe opioids and other potent pain medications are now enrolled in the state’s Prescription Drug Monitoring Program. Full enrollment in the PDMP was one of the goals set forth in Gov. Gina M. Raimondo’s overdose action plan, which aims to reduce opioid deaths by 33 percent within three years.

The PDMP, a statewide database that interfaces now with several other states’ databases, allows health care providers to view what controlled substance prescriptions have been filled for their patients. In addition to preventing over-prescribing, the PDMP can help to prevent drug diversion and unsafe combinations of prescribed medications.

Although a June 2014 law required every health care provider with a controlled substance registration to enroll with the PDMP, Dr. James McDonald, chief administrative officer of DOH’s Board of Medical Licensure and Discipline, said, “Compliance was poor; we worked under the assumption that prescribers weren’t aware of the plan.”

In January 2016, DOH issued its PDMP Education, Notification and Enforcement Plan, which McDonald described as an effort to educate and raise awareness and facilitate compliance. Before that, only 40 percent of the approximately 6,000 health care providers with controlled substance registrations had enrolled in the PDMP, McDonald said. “It was a real concerted effort to get everyone enrolled with PDMP, and by all accounts, it was very successful.” By June 2016, 95 percent of those prescribers had enrolled; now, thanks to a new law, DOH is empowered to automatically enter anyone with a controlled substance registration into the PDMP. As a result, the agency registered those few remaining prescribers into the PDMP and, going forward, will continue to do so.

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Now that DOH has achieved the goal of getting full prescriber enrollment, McDonald has some advice for every consumer of health care. “All of us should have an open dialogue with our prescribers. If you’re being prescribed an opiate, ask: ‘Is there another medicine that would do just as well for my pain?’” That’s one question, he said, that would be very welcomed by the prescriber.

Full enrollment doesn’t mean that all prescribers are checking the PDMP before initiating an opioid prescription and for every three months thereafter, as the 2016 law requires; in August, for example, only 24 percent of enrolled prescribers ran those patient reports. However, said McDonald, full registration was only achieved in July, and not every prescriber will issue an opioid prescription in any one month. With an estimated 3,000 prescribers issuing a prescription in any given month, McDonald added, “We’d like to see the utilization higher for every controlled subscription… [but they] have to overcome that barrier to access the database. We’ve done what we can to make it as easy as possible … and we’re working to [connect the PDMP] to patients’ electronic medical records.” Calling that latter effort “quite a heavy lift,” McDonald expects it will be wholly completed within the next three years.

The DOH reported that other efforts are underway to increase usage: Staff members are visiting the offices of the highest prescribers to provide additional education and information, and the agency developed a customized prescriber profile that compares providers’ prescribing patterns with statewide averages, shows PDMP usage rates and identifies patients who have visited five different prescribers and/or five different pharmacists in any one six-month period – a sign of potential drug diversion.

“Pharmacists are very much the safety net [against overprescribing],” said McDonald, who explained that the PDMP only displays information on filled and dispensed prescriptions of opioids and other controlled substance medications. Although there’s no specific law or regulation requiring pharmacists to look at the PDMP, he said, doing so is part of their professional responsibility. While DOH has seen very good utilization by pharmacists in Rhode Island of the PDMP, he acknowledged that the state has far fewer pharmacists than enrolled prescribers.

Given people’s mobility, the DOH would like to have every state’s database connected to Rhode Island’s PDMP, he said. Currently 10 states are connected: Connecticut, Massachusetts, New York, New Jersey, Virginia, Mississippi, Minnesota, Idaho, South Carolina and South Dakota. Conversely, Rhode Island’s database is connected to all of these states’ databases, except for New York’s, which is in the process of connecting the databases.

“The PDMP helps prevent over-prescribing and promotes better coordination among health care providers throughout the state to ensure that patients with chronic health needs continue to get the treatment they need in a way that is as safe as possible,” Director of Health and Overdose Task Force Co-Chair Dr. Nicole Alexander-Scott said in the DOH statement.

Additional PDMP and overdose death data is available online.

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