States Looking to Curb Opioid Abuse Should Start by Strengthening PDMPs

Prescription drug monitoring programs have existed for decades in more than a dozen states, but many like Maryland’s are underused or don’t equip doctors well enough to combat opioid addiction.

PDMPs are separate electronic databases of patients’ prescription histories that doctors can consult before prescribing a possible addict an opioid or a drug that could interact negatively with another.

Kentucky, Tennessee and New York passed legislation strengthening their PDMPs in 2013, followed by Connecticut in 2015 and Massachusetts and Wisconsin earlier this year. But Maryland senators gutted a similar bill in committee by, for instance, exempting cancer patients from having doctors review their prescription history.

“That’s so unfair to those people,” Gary Mendell, founder and CEO of Shatterproof, told Route Fifty in an interview. “So many people who’ve been treated are in remission but could say, by the language, they’re still being treated, and now a doctor doesn’t have to check like they so deserve.”

Maryland’s Senate Finance Committee also changed language in the bill reducing the amount of data the PDMP needed to keep on each patient from 12 months’ worth to six, removing a requirement that the state investigate the suspected misuse of data, and removing another requirement the program report improper dispensing to a professional society.

The city of Baltimore’s health commissioner, Leana Wen, would also like to see changes to Senate Bill 382.

“As the Health Commissioner of a city that is addressing an epidemic of drug overdose with one of the most aggressive overdose prevention programs in the country, I support all efforts to save lives, including strengthening the state’s PDMP,” Wen said in a statement. “While we are glad to support this legislation, we believe that the bill should go even further to ensure naloxone is being prescribed to all who are at risk for overdose, and that doctors are cautioned against the potentially lethal drug interaction of opioids and benzodiazepines.”

Mendell’s nonprofit, which has worked for two years to reduce the number of people addicted to alcohol and other drugs and get them science-based treatment without stigma, is urging state legislators to reconsider. Shatterproof backed the bills in Massachusetts and Wisconsin and the two in contention in Maryland and California, where legislation was passed in the Senate last year and assigned to a House committee this session.

A businessman, Mendell’s son died from addiction in October 2011, and he was surprised to learn nearly 2.5 million people suffer from opiate-use disorder and 25 million are addicted to alcohol or any drug.

Almost 30,000 people overdosed on prescription drugs in 2014, according to the National Institute on Drug Abuse.

“For every major disease, there’s usually one nationally funded organization leading efforts for a cure: the American Cancer Society, American Heart Association, Susan G. Komen, Autism Speaks,” Mendell said. “But there was nothing for addiction.”

For now, Shatterproof is focused on state legislation combating overdoses and building a grassroots event foundation to raise awareness.

According to Mendell, 86 percent of the time doctors don’t refer to PDMPs before prescribing, and states adopting the U.S. Centers for Disease Control and Prevention’s March guidelines for prescribing opioids is an important next step to help curb abuse.

The Comprehensive Addiction and Recovery Act was already approved by the U.S. Senate this year, but Shatterproof would like to see the bill amended prior to receiving House approval, making federal grants conditioned upon state medical societies adopting the CDC’s new guidelines as standards of care.

Shatterproof also supports medication-assisted treatment—the use of methadone and buprenorphine to trick the patient’s brain into thinking it’s still getting the problem opioid while they undergo rehabilitation.

“Some doctors believe patients should remain abstinent,” Mendell said. “I believe the patient should have a choice.”

Doctors would be required to undergo special training before offering such treatment under the new standards of care. U.S. Sen. Ed Markey of Massachusetts proposed an amendment to CARA, the TREAT Act, that would have increased the number of patients a qualifying doctor practicing medication-assisted treatment could treat from 30 to 100 a year, but the change wasn’t made.

Shatterproof just released a new report detailing 12 critical elements states should include in PDMP legislation, like having prescribers query the database before prescribing schedule II, III and IV drugs and proactively analyzing and distributing the data. Soon the nonprofit will release state scorecards based on their legislation in place.

“My son didn’t die of an overdose,” Mendell said. “After months of not using, he woke up one morning and took his life because he felt like an outcast, not like a patient.”