Play 5: Improve and implement better prescription monitoring programs

Summary
Laws in 49 states support the creation of PDMPs, which require pharmacies to report the sale of controlled substances in fulfillment of prescriptions. Most physicians therefore can determine if a patient has gone “doctor shopping” by seeking opioids for the same pain management from more than one physician. However, some doctors are either unaware of the system, unsure of how to use it or have concerns about its accuracy.

The goal of this play is to ensure that doctors know about and use their state system; that they check across states to ensure that a patient is not "doctor shopping;" and that the prescription history for prior medication does not indicate a new prescription should not be written. Greater use of PDMPs can be mandated legislatively, but efforts are also needed to educate and persuade physicians and pharmacists to take full advantage of this effective tool.

Example: The Kentucky All Schedule Prescription Electronic Reporting (KASPER) program is highly regarded. Among the reasons is that it mandates physician and pharmacy compliance.

Goals and Objectives
The goal of a project to improve PDMP programs is to (1) ensure that the system does as much as possible to collect and make available data on past prescriptions and other indicators helpful to making decisions on prescriptions and (2) ensure that the system is used by physicians and pharmacists in dispensing controlled substances. While PDMPs are operated at the state level, local coalitions of interest can promote the inclusion and accessibility of the system to assure its maximum effectiveness. Greater use can be mandated legislatively, but also by efforts to educate and persuade physicians and pharmacists to take advantage of this effective tool. The PDMP instituted by the Bureau of Justice Assistance has published a presentation from SAMSHA that helps define goals for this work.

Theory of Change
Having an effective and accessible PDMP, and ensuring its use in the process of dispensing medications, will reduce the number of people who begin the development of a substance use disorder because they have been prescribed excessive amounts of opioid medication.