Addressing the nation’s opioid crisis is no simple task. It’s a multi-factorial problem that must include multi-pronged solutions—including cooperation and collaboration among the medical and pharmacy communities, government, social programs, and regulatory agencies.
PDMPs (prescription drug monitoring programs) is one way that states are working with doctors to keep them informed about their patients’ opioid prescribing histories, especially as related to coordination of care with other providers. Earlier this month, Maryland and Florida joined 40 other states that now require prescribers to check PDMP databases before prescribing opioids. Maryland is also now one of 26 states that allow their PDMP databases to be integrated into the e-prescribing workflow (see infographic).
Both of these developments represent progress in the fight against the opioid crisis. Prescribers’ use of PDMP data may have contributed to the 22 percent decrease in opioid prescribing recently reported by the American Medical Association (AMA).
Information is power, and technology-enabled solutions support easier access to critical patient histories about opioids that can enable providers to improve outcomes and save lives.
How did we get here?
In 2001, the Joint Commission rolled out pain management standards that included pain as the “fifth vital sign” in hospitals, and physicians were encouraged to order pain medications, including opioids, to keep patients as comfortable as possible—with the ultimate goal of “zero pain.” Then this liberal use of opioids spilled into ambulatory care, for everything from back pain to root canals to recovery from C-sections. At that time, there was also a widely cited article that suggested that addiction from short-term opioid use was rare (citation: Porter J, Jick H. Addiction rare in patients treated with narcotics. N Engl J Med. 1980;302:123.)
Addiction to opioids occurs more rapidly and more readily than was once known, creating a perfect storm. When opioids are prescribed unnecessarily or treatment continues longer than needed, addiction issues can emerge quickly. Even worse, when patients with addiction issues can’t get prescription opioids, some may even turn to illegal street drugs such as heroin—which is increasingly laced with the dangerous agent fentanyl.
The challenge of PDMP mandates
While PDMP mandates make sense, many prescribers don’t comply with them. And, while the states with mandates do require verification once the provider checks the data, very few if any of these same states are addressing a lack of compliance in a structured manner.
Some physicians believe that PDMPs are unnecessary because they trust their own judgment. Others feel they don’t have the time to check online PDMP registries. This is understandable when doing the database checks in a traditional manner. In the absence of a specific technology solution integrated directly into the workflow, verifying whether a patient is taking opioids requires doctors to go to a stand-alone PDMP website, log on, and enter patient demographic information. In states that require such checks, doctors also must document that they looked up the data. Altogether, this process can take 3 to 5 minutes per patient. If a doctor prescribes opioids or other controlled substances several times a day, that adds half an hour of daily work.
We must make it as easy as possible for clinicians to check PDMP data so that workflows aren’t adversely impacted by already time-pressed doctors. We also need more studies on the incidence and impact of PDMP-checking. The evidence needs to support the effort.
E-prescribing workflow tool
Many states—with Maryland and Florida as the most recent—allow doctors to access PDMP data within e-prescribing tools such as DrFirst’s iPrescribe mobile application and its desktop versions, which are embedded in EHRs. As a result, prescribers gain easy, fast access to this information in their e-prescribing workflow. With just a couple of clicks, they can check the PDMP data and prescribe the appropriate drug. In the background, the software automatically documents the fact that the doctor checked the registry.
When a physician discovers that a patient may be at risk of opioid addiction or may already be addicted, she can start a conversation with that patient. If the patient acknowledges that he may need help, the doctor can use DrFirst’s integrated Backline application to securely message another clinician, a home health provider, or a social worker who can intervene.
DrFirst believes so strongly in the importance of PDMP checks and their ability to curb substance abuse that we offer iPrescribe for free for one year to prescribers. In addition to driving PDMP use, we are doing this to:
- Help doctors decrease opioid use and overdose deaths
- Make it as seamless as possible to check PDMP registries
- Build a critical mass of prescribers who use the PDMP registry
- Collect data for studies and for educating providers
To encourage physicians to check PDMP data in their e-prescribing workflow, it’s important to document and continue to demonstrate how this extra step can make a difference in patient outcomes. To do this, more studies are needed. The AMA report on the drop in opioid prescribing suggests a correlation with the rise in PDMP checks, but not necessarily a causation. Several smaller studies have been based on prescriber surveys, which can be inaccurate. We need bigger, better studies to confirm the connection between PDMP checking and outcomes.
As more physicians across the country use DrFirst’s tool to access PDMP data in their e-prescribing workflow, states will be developing a rich database that we hope will be shared with other states that allow this access. The purpose is not to punish prescribers who don’t check the registries or who prescribe too many opioids but to provide data for future studies that demonstrate the efficacy of PDMP-checking. If the evidence supports the use of PDMP databases, more prescribers will be encouraged to adopt and embrace this powerful tool—especially when they have an easy and efficient way to integrate it into their workflow.
A reduction in opioid prescribing alone will not end the opioid epidemic. The huge influx of illegal street drugs also must be addressed, and addicts must have easier access to treatment. But I’m convinced that, if all of us work together, the healthcare community can decisively reverse the trend of opioid addiction to improve outcomes and alleviate suffering.