If you have followed this column, you know I am a big proponent of prescription monitoring programs (PMPs) in this country. However, I am not a proponent of a single PMP being run nationally by a federal governmental entity. Rather, I support management by individual states that establish their own laws as to who has access and how it can be used. I don’t agree with how some of them restrict law enforcement to easily access the data, but I recognize that the whole system works better when states do their own thing!
The thought of a national PMP, which was once to be called NASPER (National All Schedules Prescription Electronic Reporting), is scary at best. As you know, many people in this country don’t think law enforcement and others should have the ability to view an individual’s prescription history. Missouri is a good example, as it remains the only state without any form of a PMP.
Regarding the privacy issue, having a federal entity manage a PMP database is a recipe for disaster. State PMPs constantly stay alert not to release the wrong information, or erroneous information to a legitimate person inquiring about a patient within the state. Imagine controlling a database with information from 50 states and keeping it free of privacy breaches. The chances for a disaster and closing of the system increase several times, and ultimately we all lose, including legitimate patients, when it is all tied up in civil litigation.
The thought with NASPER was that someone querying an individual in Ohio, for example, could learn if the individual is doctor shopping in Arizona. This way, the whole country would be covered with just 1 simple query. On the surface, it sounds like a good idea, until you think about the bureaucracy mentioned above and the fact that if someone is seeing multiple doctors in Ohio, an investigator only needs to know information from bordering states, not the entire nation, and very unlikely Arizona.
The National Association of Boards of Pharmacy PMP Inter-Connect program, launched in 2011, is a way for each state to continue restricting its information as it sees fit, but to have it available to certain other states that conduct a query on a patient. If a certain state restricts law enforcement from viewing data, but allows prescribers to do so, then being involved in this worthwhile program would not compromise any state laws or regulations. It would be equally important for a state to continue to operate its own PMP using its resources to keep the system running and free of compromises.
As I have said many times before, the PMP has been a remarkable tool for those looking at prescription drug profiles. Prescribers are able to provide better treatment for their patients and sniff out possible diversion by individuals who are doctor shopping or are involved in some kind of prescription crime. Law enforcement can much more quickly and efficiently look at the data to determine if crimes are being committed, while safeguarding a patient’s identity during an investigation.
One thing that’s coming in some states is mandatory use of the state PMP before prescribing a controlled substance to a patient. This seems necessary, as a relatively few prescribers are checking on their patients before an opioid is prescribed. Prescribers cite reasons such as inconvenience and a lack of time, but the truth is that with the prevalence of prescription drug abuse, some states are moving toward mandatory compliance in the hope of curbing this nationwide problem.
If you are a pharmacist, I strongly encourage you to use your state PMP (unless you are in Missouri). Your state PMP is one of the best weapons to combat Rx abuse and could relieve you of some of the liability that you might incur by dispensing to someone who is doctor shopping. In addition, don’t forget to check the photo identification of customers picking up controlled substance prescriptions!