As Massachusetts unveils new PMP, old questions remain
Monday, August 15, 2016
With high hopes for an easier to use and more efficient website, Massachusetts has announced the launch of their new prescription monitoring program (PMP) website known as the Massachusetts Prescription Awareness Tool, or MassPAT. The site will have all the same capabilities of the current PMP tool, but boasts a more user-friendly interface and efficient search engine.
"The current PMP gives us valuable data and insight into opioid prescription trends, but is clunky and not very clinically usable," DPH Commissioner Dr. Monica Bharel said. "This new system will make it easier for prescribers and pharmacists to access and submit information; and will allow for enhanced reporting for both physicians and DPH."
The new system is set to go live Aug. 22.
But while a fancy new website might make searching faster (and thereby more convenient), old questions still remain about the impact of these prescription monitoring programs on prescribing habits. For example, studies have been done to evaluate the impact of using a PMP by emergency room prescribers and have found no significant changes in prescribing patterns resulting from the use of the PMP.
An observational study in 2011 compared states with and without prescription drug monitoring programs and concluded that "it can be said unequivocally that PDMP states did not do any better than the non-PDMP states in controlling the rise in drug overdose mortality." Another study published in 2013 concluded "PDMP data influenced prescribing behavior in only 9.5 percent of cases and resulted in more prescribing."
Is more information really the answer? Will a sleek new website suddenly produce a dramatic change in the prescribing habits of the physicians in the state?
Or is the problem possibly that we already have more than enough information, and we simply don't know what to do with it?
I tend to think the latter is the case. And I'm not alone.
In an article entitled "Prescription Drug Monitoring Programs: Examining Limitations and Future Approaches" published in 2015 in the Western Journal of Emergency Medicine, the physician authors state, "To date, there is no agreed upon threshold to define questionable behavior, and each government agency or clinician is left to decide what criteria should cause them concern. The lack of objective criteria creates a challenge for clinicians who are balancing their duty to treat pain, to meet patient expectations, and to prevent misuse and diversion in their communities."
As a pharmacist working on the front lines of the opioid prescribing, dispensing and overdose crisis, I can sympathize with the doctors who are trying to do the right thing only to be taken advantage of by drug diversion, which they had no way of knowing about. I also sympathize with pharmacists who have limited time to review PMP data that — at best — only shows utilization and gives us no information on the patient treatment plan, diagnosis or other factors that may be relevant to their opioid use.
And, of course, I also sympathize with patients who truly need the help of opioids to make it through the day and find the restrictiveness of these products to impact the quality of the healthcare they receive. They are sometimes forced to live with a stigma they don't deserve.
All that being said, we can do much better to curb the overprescribing going on, and the drug diversion that results from it. I find it baffling that you can go online and find out if your doctor got a free lunch from a drug rep, but you can't find out if the opiates they prescribed ended up contributing to someone's death. A doctor or hospital can be penalized by patients reporting "poor pain control," but there seems to be no penalty for giving excessive amounts of oxycodone.
One of the most effective treatments available today for opioid addiction is Suboxone (buprenorphine and naloxone). Yet doctors must jump through hoops to prescribe it, they are limited to the number of patients they can treat, and insurance plans are allowed to implement burdensome prior authorization requirements. It just makes no sense.
So while I'm glad to see a more user-friendly PMP website get launched in Massachusetts, I'm concerned that we don't satisfy ourselves with a shiny new toy in exchange for the type of real reformations needed to prevent addiction and help patients who are already addicted with resources they need for recovery.
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