Prescription Monitoring Should Be For Public Health, Not Enforcement: States

 

Prescription monitoring programs are increasingly
favored by law enforcement to track — and catch —
patients who doctor-shop and doctors who “overprescribe,”
with opioids being the most serious problem.
However, prescription drug abuse is a health problem
like alcohol or heroin abuse that should lead patients
to treatment, according to the state substance abuse
directors in Vermont, Maine, and Maryland.

Those are the only three states in which the SSA
(single state authority) has control of the monitoring
programs. (Other states situate them in law enforcement
because diversion is the focus of the Department
of Justice-funded Hal Rogers prescription drug
monitoring program grants.)

Maine, which has the highest per-capita prescription
opioid consumption in the country, instituted its
Prescription Monitoring Program (PMP) after a 2003
law mandated that the state be informed of controlled
substances prescriptions. The legislative intent of the
law is clearly spelled out in the statute: “a means to
promote the public health and welfare and to detect
and prevent substance abuse.”

The law was spearheaded by former Rep. Anne C.
Perry, a nurse practitioner who worked for an opioid
treatment program and was frustrated by not having
patients’ prescriptions in their medical history, recalled
Guy Cousins, director of the Office of Substance Abuse
(OSA), Department of Health and Human Services.
“She saw this as an intervention opportunity,” Cousins,
SSA for Maine, told ADAW. And that is the way the PMP
is used in Maine — as a way for medical providers to
refer people to substance abuse treatment.

“It’s a best practice, a standard of care, to help guide
people into treatment,” said Cousins. OTPs do not give
information about methadone to the PMP, but can access
it, said Cousins.

Vermont

The Vermont Prescription Monitoring System (VPMS)
is based on Maine’s PMP because of the public-health
focus, said Barbara Cimaglio, deputy commissioner for
alcohol and drug abuse programs in the Department
of Health. Vermont’s 2007 legislation establishing the
VPMS, explicitly defined the purpose as helping physicians
and practitioners “get information they need
to improve patient care,” Cimaglio told ADAW. “If you
look at the purposes of others that aren’t based in the
health department, it’s law enforcement. Having it
based in the health department is a big deal.”
The health department “starts with the basic assumption
that people get prescriptions from physicians, and
physicians are trying to do their best to give appropriate
care,” said Cimaglio. “This is a medical program.”
And the doctors, when they identify a problem, are
then to refer a patient to treatment — which in Vermont
is expanding to accommodate more patients
addicted to opioids. Whether they are getting them
through doctor-shopping, stealing them from nursing
homes, buying them from the street, or in some other
way, they have the medical condition of addiction, she
said. “That they should get treatment goes without
saying,” she said.

Maryland

Maryland’s Prescription Drug Monitoring Program
(PDMP) is the newest to be overseen by the SSA —
Thomas P. Cargiulo, Pharm. D., director of the Alcohol
and Drug Abuse Administration (ADAA). “The main
reason was that this is more of a public health issue
than a criminal justice issue,” Cargiulo told ADAW.
“Let’s look at this as the chronic disease it is and get
people referred to treatment,” he said. “Especially with
prescription drug abuse, people haven’t committed a
crime. Doctor-shopping, trying to get more prescriptions,
isn’t illegal.”

Cargiullo, a pharmacist, said physicians and pharmacists
will be trained in how to give out referrals so that
people who are abusing prescription drugs can get
into treatment “before they reach the criminal justice
system.” Doctors are also going to use screening and
brief intervention to try to identify patients who need
treatment. “We hope this will increase the demand for
treatment,” he said.

Pressure from law enforcement

Admitting that there is always pressure from law enforcement
for the data, the SSAs say that they impose
limits on what information outside people can obtain.
“There are clear guidelines for how the legal profession
can access data,” said Maine’s Cousins. “We just
keep going back to the intent of the statute, that it’s
for interventions.” If there is a crime under investigation,
“we do work collaboratively” with enforcement,
said Cousins.

Vermont is doing the same thing, because there is a
“huge problem” with diversion there, said Cimaglio.
“We’re working to add a provision so that certain drug
enforcement investigators can have access to data under
limited circumstances.” Under current Vermont law,
law enforcement can get information about prescriptions
from pharmacies if they are investigating a case.
But the VPMS would make it easier by giving them the
information “in a more compiled way,” she said.

As in Maine, OTPs do not report to the database. “They
dispense, and don’t prescribe,” she said. Buprenorphine
prescriptions are reported. They are not protected
under 42 CFR Part 2 because the patients are getting
buprenorphine from primary care physicians who
are not addiction treatment programs, and therefore
not covered under the confidentiality law, she said.

In Maryland, law enforcement will have to get a subpoena
to access the database, said Cargiullo. “If you
have a court order, you can get the information released,”
he said.

For more about Maine’s PMP, go to
http://www.maine.gov/dhhs/osa/data/pmp/

For more about Vermont’s VPMS, go to
http://healthvermont.gov/adap/Vpms.aspx.

For more about Maryland’s PDMP, go to
http://maryland-adaa.org/PDMP.html.

 

By Alison Knopf

 

Prescription monitoring should be for public health,
not enforcement: States was first published in Alcoholism
& Drug Abuse Weekly Volume 24, No. 8, February
20, 2012.