STATE PRESCRIPTION DRUG MONITORING PROGRAMS

To support continued state implementation of prescription drug monitoring programs that collect real-time, relevant, and standard information from all dispensing outpatient entities about controlled substances and monitored prescriptions; further,

To advocate that such programs and states seek adoption into health information exchanges to best integrate into electronic health records and to allow prescribers, the pharmacy workforce, and other practitioners to proactively monitor data for appropriate assessment and dispensing; further,

To advocate that such programs improve their interstate data integration to enhance clinical decision-making and end-user satisfaction; further,

To advocate against unilateral use of these systems that may lead to patient stigmatization or prevent them from seeking appropriate medical care; further,

To encourage policies that allow the pharmacy workforce to gain access to databases without holding licensure in each state; further,

To promote research on the effects of prescription drug monitoring programs and electronic health record programs on prescribing, dispensing, misuse, morbidity, and mortality.

Rationale

ASHP recognizes the important contributions to public health made by state prescription drug monitoring programs (PDMPs). To be effective, these programs need to be mandatory; must collect standardized, relevant, and real-time information for analysis and comparison among states; and need to be universal and accessible by the pharmacy workforce. However, reporting of information to the PDMP should not be used for the purposes of stigmatizing patients or criminalizing the provision of necessary patient care (e.g., requiring reporting of mifepristone prescriptions).

All states have implemented PDMPs, with the final state, Missouri, implementing its PDMP on January 20, 2023. While this is a great step forward, continued improvement of PDMP utilization is required. A recent review of PDMP reviews by Tay et al. in the Journal of Drug and Alcohol Dependence identified the following still-existing barriers: PDMP system-related functionality (i.e., usability, data quality), end-user-related experience (i.e., satisfaction, workflow efficiency), and broader issues (i.e., electronic health record [EHR] integration, data sharing). More importantly, not all states mandate provider use of PDMP prior to controlled substance prescribing, and states that do mandate its use are slow to hold providers/pharmacists accountable for not using it. Due to these factors, it is difficult for practitioners to make relevant clinical decisions.

Improved data sharing between different jurisdictions, enhanced interoperability with EHRs and information exchanges, and increased evidence of PDMPs’ impacts on patient outcomes are needed to increase utilization and augment states’ PDMPs. Finally, adequate state and federal funding is essential to sustain the viability of these programs and to encourage research, education, and implementation of best practices in PDMPs.