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Prescription Drug Monitoring Program (PDMP)Maryland Alcohol and Drug Abuse Administration
PDMP Goals•Assist medical, pharmacy and public health
professionals in the identification and prevention of prescription drug abuse
•Assist law enforcement and regulatory agencies in the identification and investigation of illegal prescription drug diversion
•Promote a balanced use of prescription data that preserves the professional practice of healthcare providers and patient access to optimal pharmaceutical-assisted care.
PDMP ObjectivesGive healthcare providers “real time” access to patient controlled substance Rx history to:• identify “doctor shopping,” indicating Rx abuse or diversion• Intervene with Rx abusing patients => treatment referral or develop comprehensive clinical care• Increase provider awareness of and ability to deal with substance abuse• Improve provider ability to manage pain effectively• Increase confidence in prescribing decisions• Increase ability to determine patient compliance
Rx Drug Abuse: National Trends• Massive increase in prescribing of drugs
with abuse potential for treatment of pain, anxiety and other disorders: 402% increase in mg/person use of opioids 1997- 2007
• Fueled by increases in Rx-related overdoses, drug overdoses became the #1 cause of unintentional death in 2009
• Fatal opioid-related overdoses triple 1999-2006, now more than heroin and cocaine combined
• ED visits for non-medical opioid use increased 111% 2004-2008; 84% for benzodiazepines
Rx Drug Abuse in Maryland• Rx-related admissions to ADAA-funded
treatment providers nearly doubled between 2007 and 2010, accounting for 1 in 5 admissions in 2010
• Oxycodone exposure calls to MD Poison Center rose by over 250% between FY2007-FY2010
• Office of the Chief Medical Examiner reports that 55% of “intoxication” deaths in 2010 involved a prescription opioid
What is the Prescription Drug Monitoring Program (PDMP)?
•Electronic monitoring of the prescribing and dispensing of Schedules II-V Controlled Dangerous Substances (CDS)
•Create CDS prescription database •Make prescription data available to:
Schedules II-V CDS include:Opioids/Opiates
Benzodiazepines
Psychostimulants
PDMP Facts• 48 states w/ legislation; 35 operational
• State PDMPs vary widely
• Housed in health depts, pharmacy boards, substance abuse authorities, attorney general offices, state narcotics enforcement agencies
• Monitor one, a few or all CDS drug schedules
• Different reporting periods
• Allow various groups different levels of access
• Some only react to data requests, some actively analyze data and issue reports to prescribers, dispensers, law enforcement, licensing boards, etc.
PDMP in Maryland•Prior legislative attempts: 2006 (passed
unanimously, vetoed), PDMP Advisory Council created in 2008 & issued report recommending creation of PDMP in 2009, 2010 (failed)
•2011: authorizing legislation (SB883) passed with bipartisan support
•Law officially effective October 1, 2011•Actual data collection estimated to begin
in Summer 2012•Housed in ADAA•Currently funded by federal grants
How Does the PDMP Work?
For each CDS Rx dispensed, dispenser must electronically report to ADAA identifying information for:
• Patient for whom drug is prescribed (name, gender, address, DOB, etc.)
• Prescriber (DEA #)
• Dispenser (DEA #)
• Drug (NDC, quantity, dose amount, days supply, etc.)
Reporting Exemptions•Dispensing or direct administration to
inpatients in a licensed healthcare facility
•Dispensers exclusively serving residents of assisted living, comprehensive care and developmental disabilities facilities
•Opioid maintenance program dispensing
•Veterinarian dispensing
•Dispensing to hospice inpatients if dispenser is granted waiver by DHMH
Who Can Request Rx data?•Prescribers (in connection with care of patient)
•Dispensers (in connection with dispensing request)
•Law Enforcement (judicial subpoena required)
•Licensing Board (administrative subpoena required)
•Patient (may include parent/guardian for minors)
•Units of DHMH (existing investigation required)
•Other states’ PDMPs (if authorized and employing confidentiality, security and access standards at least as stringent as MD’s PDMP)
•Researchers (de-identified data only)
Other Legislative Provisions• 5 year sunset
• PDMP may not “unduly” increase dispeners’ workload or expense and must provide the IT for reporting
• Data are confidential, privileged, not subject to discovery or subpoena in civil litigation, not public records
• Prescribers & dispeners not required to check database; no liability for failing to check
• Civil penalty for dispenser failure to report
• Criminal penalty for unauthorized disclosure
• Process for patients to correct errors in record
PDMP Advisory Board•Make recommendations on PDMP design &
implementation and report to legislature
•Design evaluation component: what impact is PDMP making on Rx abuse/diversion and legitimate patient access to CDS?
•Multidisciplinary group composed of:
Current PDMP Tasks•Advisory Board first meeting (October
2011)•Draft regulations (enacted by early 2012)•Determine proper IT to support program
- RFP for vendor services- integration with Statewide Health Information Exchange (HIE)
•Secure funding•Create PDMP website•Develop program educational materials
