March 18, 2012
Prescription Monitoring Program
DESCRIPTION: A PMP is a statewide electronic database which collects designated data on substances dispensed in the state. The PMP is housed by a specified statewide regulatory, administrative or law enforcement agency. The housing agency distributes data from the database to individuals who are authorized under state law to receive the information for purposes of their profession.
The states have received plenty of federal funding from the DOJ for the creation of PMP’s.
the Bureau of Justice Assistance (BJA), Office of Justice Programs in the U.S. Department of Justice created the Harold Rogers Prescription Drug Monitoring Program (HRPDMP) in 2002 (3).
Funds for this program were provided by Congress to assist in the planning, implementation, and in some cases the enhancement of state PDMPs. From 2002 to 2008, over 100 state HRPDMP grants were awarded by the BJA.
For fiscal year (FY) 2009, $7 million was appropriated by Congress for the HRPDMP. President Barack Obama proposed that the budget for 2010 would include $7 million for the grant program (4).
The goal of the State of Oklahoma is to reduce prescription fraud, substance abuse, “doctor shopping”, and other illegal activity related to pharmaceutical drug diversion. The Bureau works in partnership with pharmacies, practitioners and other health care professionals throughout Oklahoma to reduce prescription drug abuse.
The Oklahoma Prescription Monitoring Program (PMP) was enacted into law by the Oklahoma Anti-Drug Diversion Act (63 O.S. Section: 2-309). http://www.ok.gov/obndd/Prescription_Monitoring_Program/
Oklahoma is credited as the first state to begin using a prescription monitoring program back in the early 90’s. Now Oklahoma has raced to the top again with its high tech, electronic PMP that boasts real time prescription data sharing beginning this year.
The Oklahoma Bureau of Narcotics and Dangerous Drugs Control started the monitoring program in 2006 to reduce prescription fraud, substance abuse and “doctor shopping.” http://newsok.com/real-time-reporting-law-could-cut-down-on-prescription-abuse-fraud-oklahoma-officials-say/article/3646147#ixzz1osdhdWGx
Oklahoma’s modern electronic PMP has been running since 2006 and three quarters of doctors and pharmacies use the program.
Oklahoma to Track Prescription Drug Abuse
Under a statewide database program to be administered by the Oklahoma Bureau of Narcotics and Dangerous Drugs Control, authorities will track instances in which substance abusers try to fraudulently acquire prescription drugs
. . .”The CONTROL project is a vital tool that will help crack down on prescription drug abuse and help get desperately needed treatment for people suffering addiction,” (Emphasis mine) Gov. Henry said at a state Capitol news conference.
. . .Under CONTROL, physicians and pharmacists will be able to check a patient’s prescription history from hospitals, clinics and pharmacies to deduce whether that person is “doctor shopping” for drugs. The entire process, which includes safeguards to prevent abuse, will take only a matter of minutes.. . . The program goes online July 1 and is entirely funded through federal grants. Oklahoma to Track Prescription Drug Abuse
With all of these firsts for Oklahoma in prescription drug monitoring, doesn’t it seem rather ironic that the state also boasts #1 status in prescription drug use and in painkiller abuse?
Oklahoma is #1 in prescription drug use per capita
Oklahoma is #1 in painkiller abuse
The report [Centers for Disease Control] says that Oklahoma leads statistics with the highest number of people — 1 in 12 — using painkillers recreationally.
Nov. 10, 2011 http://www.officer.com/news/10449255/okla-police-working-to-stop-prescription-drug-abuse
Last year, about 240,000 people in Oklahoma, or 8%, abused prescription drugs, giving the state the highest mark in the nation, although New Mexico and West Virginia lead in per-capita overdose deaths.
Prescription drugs are responsible for four in five overdose deaths in Oklahoma. The leading causes of drug-related deaths in Oklahoma in 2010 were hydrocodone, oxycodone and alprasolam. http://www.allgov.com/Controversies/ViewNews/Drug_Addiction_in_Oklahoma_Costs_More_than_Entire_State_Budget_120313
While the Oklahoma PMP monitors a wide range of drugs (all schedule II-V) it is the painkillers that are causing the brunt of the deaths and addiction related problems such as doctor shopping which the PMP is tailor made to address.
Oxycodone addiction and abuse, in particular a drug called OcyContin, is without a doubt a horrible problem. Over the years I have personally heard of numerous cases of addiction and accidental overdoses from OxyContin. The maker of the drug, Purdue, back in the mid 90’s, presented their new formulation of the drug oxycodone as less addictive and safer that the older preparations for the drug
Purdue knew it needed to overcome doctors’ fears about addiction, so it treated the time-release formula as a magic bullet. It claimed the drug would give pain patients steadier 12-hour coverage, avoid withdrawal, and frustrate addicts seeking a euphoric rush. As one 1998 Purdue promotional video stated, the rate of addiction for opioid users treated by doctors is “much less than 1%.”
The pitch worked, and sales took off: from $45 million in 1996 to $1.5 billion in 2002 to nearly $3 billion by 2009. The key: Nearly half of those prescribing OxyContin were primary-care doctors rather than, say, cancer specialists, the General Accounting Office reported. Purdue had succeeded in vastly expanding the market for its drug http://features.blogs.fortune.cnn.com/2011/11/09/oxycontin-purdue-pharma/
Purdue aggressively marketed the painkiller and downplayed the risk of addiction at the expense of lives. The company was prosecuted for its misleading campaign, found guilty and had to pay out millions in fines.
When it was introduced in the late ’90s, OxyContin was touted as nearly addiction-proof — only to leave a trail of dependence and destruction. Its marketing was misleading enough that Purdue pleaded guilty in 2007 to a federal criminal count of misbranding the drug “with intent to defraud and mislead the public,” paid $635 million in penalties, and today remains on the corporate equivalent of probation. http://features.blogs.fortune.cnn.com/2011/11/09/oxycontin-purdue-pharma/
So big Pharma worked its magic and we are left to deal with the fallout. Prescription Monitoring Programs are being offered as a solution to the death and destruction wrought by prescription drug addiction but I can find nothing to show that the program is doing much, if anything, to help.
Prescription-drug overdoses are major killer in Oklahoma
The number of fatal drug overdoses in Oklahoma more than doubled over the past 10 years, climbing to 739 in 2010. . .
The PMP is a statewide database program administered by the Oklahoma Bureau of Narcotics and Dangerous Drugs Control, a law enforcement agency.
These state programs are now being linked for the purpose of sharing this information across state lines around the nation.
This 2002, a General Accounting Office report concluded that state PDMPs were a helpful tool for reducing drug diversion based not on any hard facts or numbers but on enthusiastic reports from law enforcement users and PDMP managers. (GAO Report to the Subcommittee on Oversight and Investigations, Committee on Energy and Commerce, House of Representatives. Prescription Drugs: State Monitoring Programs Provide Useful Tool to Reduce Diversion. May 2002. http://www.gao.gov/new.items/d02634.pdf.)
Here is some insight from a 2011 study that “. . .evaluated the association of PDMPs with drug overdose mortality rates and consumption of prescription opioid medications in the United States during 1999–2005.”
Conclusions. While PDMPs are potentially an important tool to prevent the nonmedical use of prescribed controlled substances, their impact is not reflected in drug overdose mortality rates. Their effect on overall consumption of opioids appears to be minimal.
PDMPs were not associated with lower drug overdose mortality rates for any of the study years or with decreases (or even with lesser increases) in the rates of death resulting from drug overdoses.
The findings also indicate that PDMPs were not associated with lower rates of consumption of opioids during 1999–2005. . . Even when focused on proactive PDMPs or programs with relatively high rates of reporting, there were no associations of PDMPs with trends in overdose deaths or opioid use. . . . it can be said unequivocally that PDMP states did not do any better than non-PDMP states in controlling the rise in drug overdose mortality from 1999 to 2005
Source: 2011 Prescription Drug Monitoring Programs and Death Rates from Drug Overdose.
In a nutshell;
- PMP’s showed no effect on the number of deaths from drug overdoses.
- PMP’s showed no effect on levels of consumption of painkillers
- The states with PMP fared no better in controlling the rise in drug overdose mortality. (In Oklahoma’s case, we actually fared worse that states with no PMP!)
Nevertheless, we are being treated to a deluge of news stories bringing us heart wrenching tales of lives lost or ruined by prescription painkiller abuse. These same stories offer the salvation of a nationwide integrated government prescription tracking database for everyone. The fact that this is an invasion of our medical privacy and a violation of doctor-patient confidentiality is never mentioned in these stories.
Who is Authorized to Request Patient Prescription Data? (Apparently just about everyone BUT you)
- Prescribers YES
- Pharmacists YES
- Pharmacies YES
- Law Enforcement YES
- Licensing Boards YES
- Patients NO
- If other requester (specify) Attorney General, Medical Examiners
The PMP’s are (in some states like Oklahoma) law enforcement programs, funded by law enforcement agencies for the purpose of feeding your personal information to law enforcement as an investigative tool. Another way to say it, is they are spying on the majority of law abiding people because they might do something wrong.
Aren’t we are supposed to presumed innocent until proven guilty? If we are doing nothing wrong, aren’t we supposed to be left alone? Yes! That is exactly how it is supposed to be.
The National Alliance for Model State Drug Laws (NAMSDL) recommends;
Monitoring systems should proactively provide information to law enforcement agencies, licensing officials, and other appropriate individuals. This information should be reviewed by a drug monitoring official and if there is reason to suspect that a violation has occurred, the offender should be reported to the appropriate agency.
In addition, a statute must be in place that allows programs to disclose information for public research, policy, and educational purposes. . .(Emphasis mine)
I don’t know about you but the idea of my medical information being accessed by a variety of people ( all benevolent and caring as they may be) makes me feel violated and powerless. This is very personal information!
Prescription tracking: Too invasive? Steve Klearman September 07, 2008
The push for monitoring is coming not just from doctors and public health officials but the attorney general’s office. And it would likely be a useful tool. But it’s easy to imagine a time when lobbyists could convince lawmakers that the drug problem has become severe enough to grant law enforcement agencies unfettered access to everyone’s prescription history without a warrant. Then, agents would view the private medical information of hordes of innocent people in hopes of nabbing a small number of abusers.
. . . Even more troubling is the thought that computer hackers or bribed employees could obtain the records and sell them. The information would be very valuable to pharmaceutical companies, and to insurers and employers who want to avoid both abusers and people in need of expensive health care. http://reno.injuryboard.com/fda-and-prescription-drugs/prescription-tracking-too-invasive.aspx?googleid=246936
Mr. Klearman’s concerns about the databases being hacked were born out in 2009. In May 2009, hackers gained access to Virginia’s Prescription Monitoring Program and held 8 million patient records hostage for 10 million dollars in ransom.
Hackers Break Into Virginia Health Professions Database, Demand Ransom
Oklahoma prescription drug monitoring: what’s collected? by Paul Monies July 5, 2011
. . . .
Senate Bill 1159, by Republicans Sen. Anthony Sykes and Rep. Randy Terrill, expanded the information collected under the PMP program to include the address and date of birth of patients getting a prescription for certain classes of drugs.
Here’s what the PMP program collects on each prescription, according to Oklahoma law and the administrative rules of OBNDD:
A. Section 2-309C. A. A dispenser of a Schedule II, III, IV or V controlled dangerous substance, except Schedule V substances that contain any detectable quantity of pseudoephedrine, its salts or optical isomers, or salts of optical isomers shall transmit to a central repository designated by the Oklahoma Bureau of Narcotics and Dangerous Drugs Control using the American Society for Automation in Pharmacy’s (ASAP) Telecommunications Format for Controlled Substances version designated in rules by the Oklahoma Bureau of Narcotics and Dangerous Drugs Control, the following information for each dispensation:
1. Recipient’s name;
2. Recipient’s address;
3. Recipient’s date of birth;
4. Recipient’s identification number;
5. National Drug Code number of the substance dispensed;
6. Date of the dispensation;
7. Quantity of the substance dispensed;
8. Prescriber’s United States Drug Enforcement Agency registration number; and
9. Dispenser’s registration number; and
10. Other information as required by administrative rule.
B. The information required by this section shall be transmitted:
1. In a format or other media designated acceptable by the Oklahoma Bureau of Narcotics and Dangerous Drugs Control; and
2. Within twenty-four (24) hours of the time that the substance is dispensed. Beginning January 1, 2012, all information shall be submitted on a real-time log.
Oklahoma prescription drug monitoring: what’s collected? by Paul Monies July 5, 2011
The Prescription Monitoring Programs are indeed a violation of privacy but when you have people dying of prescription drug overdoses, for some, the trade-off might seem reasonable. It is important to point out in response to the media saturation of tragic tales in support of the PMP, that there is no indication whatsoever that the invasive surveillance of our medical information does anything to reduce the problem. I will be interested in researching just what sort of measures are in place to get an addict some help once caught by the PMP but from what I have seen so far, this appears to be just one more invasive program to track and control Americans in the name of safety.