You broke it, you own it.

A bill before the US House and Senate would have required physicians and pharmacists to check state databases before prescribing or dispensing opioids.

All available research shows this is the single most effective step to reduce opioid abuse and kill fewer people.

Now, thanks to “doctors and pharmacists groups”, that requirement has been stripped from the bill.  What’s left is some – but nowhere near enough – money for treatment and the hope that, against all evidence to the contrary, docs who are writing the scripts that are causing the opioid disaster will take the time to check the databases before they write the script.

Not going to happen.

I am sympathetic to the claim that mandatory Prescription Drug Monitoring Program (PDMP) checking can be time-consuming. States have to do a better job of figuring out how to streamline the process while protecting patient confidentiality – and many have done so.  Moreover, the four states with mandatory PDMPs have figured it out, and it is working pretty well.

I am a whole lot less sympathetic to the argument that somehow a moment or two of a doctor’s or pharmacist’s time is too much to ask, for the simple reason that these medical professionals’ failure to properly prescribe and dispense opioids is the proximal cause of the opioid public health disaster.

Pretty much every independent research organization studying the issue has recommended mandatory PDMP checking.  Here’s one.

More bluntly, that behavior is killing people, and the lobbying to strip mandatory use of PDMPs shows that’s not that big a deal.

Kentucky, New York, Ohio, and Tennessee all mandate prescribers access PDMPs – and all have seen dramatic reductions in doctor shopping and opioid script volume.

There’s a wealth of supporting data here.  Briefly, here’s what mandatory PDMP use does.

  • after Ohio ER docs checked the PDMP, they changed their treatment plan for 41% of patients; 61% had fewer or no opioids prescribed, 39% had more.  And doctor shopping dropped by over 2/3.
  • In Tennessee, doctor shopping dropped by 50% and the volume of opioid scripts decreased by almost half a million scripts.
  • Kentucky doctor shopping was cut in half, 30% fewer patients received the “holy trinity” drug cocktail, and benzo and opioid scripts dropped significantly.
  • in New York, doctor shopping was cut by 90%, and treatment admissions rose by 20%.

After spending a fruitless hour searching the web for an actual policy statement or testimony regarding mandatory PDMP use by the AMA, my conclusion is the giant medical society wants it both ways.

They don’t want their members to have to check PDMPs, but they don’t want to be public about that opposition.

What does this mean for you?

Refusing to support mandatory PDMP is unconscionable.  At some point an enterprising class-action firm is going to figure out how to make a shipload of money off the intransigence of “doctors and pharmacists groups.”

 

3 thoughts on “You broke it, you own it.

  1. Could not agree more, Joe. The good news is states get it. New Mexico passed a law in March, effective 1/1/17, requiring access to their PDMP that was unanimous in both the House & Senate. South Carolina is now requiring access of their PDMP for Medicaid/state health plans. SB 482 in California that would require mandatory access of CURES has some very positive momentum. WC Magazine published on 5/23/16 an article I wrote entitled “Positive PDMP Progress” that mirrors a lot of what you said. As far as I’m concerned, and you’re concerned, there is no reasonable objection to mandatory access other than lack of technical capabilities of the PDMP (which is lacking in some states and needs to be fixed). Thanks for using your bully pulpit to discuss this important subject – it will take a choir of reasoned voices to drown out the unreasonable excuses.

  2. CURES in California is working very well and any provider that is not using this tool prior to seeing a new patient or on follow up is not practicing up to Standard. The wise practitioners are all using CURES and are very cognizant of the fact that opioid abuse is rampant and they do not want to be caught in the doctor shopping scenario or in dealing with a bad outcome.

  3. Maine passed LD 1646 in this year’s legislative session .Legislation typically becomes effective 90 days after the legislature adjourns . This bill requires some infrastructure development . Because of that the bill take effect on January 1,2017 . Both medical providers and hospitals worked with the governor and legislature on the bill .

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