Sweeping opioid bill won't require doctors to check database for abusers

Patient advocates say the opioid abuse bill Congress passed this month—even without the additional funding many wanted—will open doors for people seeking treatment by effectively decriminalizing addiction.

But some of the same people say lawmakers blew an opportunity to strengthen the country's ability to track the opioid prescriptions that are fueling an epidemic of overdose deaths. An older version of the Comprehensive Addiction and Recovery Act would have boosted grants for databases that flag overusers of prescription drugs—but only for states that require physicians to check those databases before writing a prescription. But physicians lobbied against the requirement, arguing that it was burdensome and that the databases, known as prescription drug monitoring programs, often failed to provide the most updated and comprehensive information.

The final bill provides the grant money but eliminated the requirement. Gary Mendell, founder and CEO of the national anti-addiction advocacy organization Shatterproof, said the omission could have a potentially “tragic effect for families across our country.”

“Without this incentive tied to federal grants, legislation at the state level will be adopted slower than it would with grants conditioned upon this requirement,” he said.

Prescription drug monitoring programs, or PDMPs, were first established by states in the 1930s. The programs now exist in every state and the District of Columbia with the exception of Missouri, where repeated attempts in the Legislature have faced opposition from privacy rights groups.

The databases collect, monitor and analyze information from pharmacies and prescribers to identify whether a patient is seeking multiple prescriptions of a medication such as an opioid, a practice most commonly known as “doctor shopping.”

The programs also alert providers when a patient has been prescribed other medications that could be dangerous when mixed with an opioid. For example, studies show mixing opioids with tranquilizers increases the likelihood of an overdose by four times.

Evidence suggests that providers who use the databases prescribe fewer opioids. A Health Affairs study in June found a 30% reduction in the rate of Schedule II opioid prescribing from 2001 to 2010 among 24 states immediately after launching a drug monitoring program.

But despite the benefits, the programs remain underutilized. The median rate of registration among prescribers was about 35%, according to a 2012 report from the U.S. Justice Department's Bureau of Justice Assistance. A 2015 study in Health Affairs found 72% of physicians surveyed were aware of their state's programs, but only 53% used them.

Only 22 states require prescribers to check the databases, and providers rarely do so before prescribing opioids in states where it is voluntary—only 14% of the time according to a 2015 review by Brandeis University researchers. Even so, the medical community is divided over whether physicians should be compelled to use the PDMPs.

The American Medical Association, however, calls for the voluntary use of state-based prescription drug monitoring programs “when clinically appropriate.”

But Baltimore City Health Commissioner Dr. Leana Wen said the opioid overdose epidemic means “we need every tool in our toolbox, and requiring the use of PDMPs is an important tool.”

Wen acknowledged that PDMPs could be easier to use. They often require a provider to log into a different system than an electronic health record system. And not all state systems share their data, meaning the information can sometimes be incomplete. Establishing a national database would address that issue, she said, and that should have been a priority in the new legislation.

Calls to establish a national prescription drug monitoring database have grown louder in recent years because of the drug abuse epidemic. In 2014, more than 18,000 people died of overdoses of prescription opioid painkillers.

“We have this national problem, and in my mind we have the means for a national solution,” said Tom Bizzaro, vice president of health policy and industry relations for health data firm First Databank. “But we're still dependent on these individual state programs.”

Yet some argue a national database would actually be less successful than improving current state programs.

“The technology is already built in the states,” said Mendell, the Shatterproof founder who does not support creating a national system. “Within two years every state in our nation can, with highly efficient PDMPs, share data with all 50 states and, equally important, have control at the state level that fosters innovation that would otherwise be stifled.”

Efforts to strengthen the state programs began immediately after Congress passed the Comprehensive Addiction and Recovery Act. The same day, Sens. Amy Klobuchar (D-Minn.), Joe Manchin (D-W.Va.), and Angus King (I-Maine) introduced a bill that says if states want the grants they must require practitioners to consult the databases.

The bill also would compel drug dispensers in states that receive federal funding to report to their PDMP within 24 hours of prescribing controlled substances; require states to notify prescribers when the PDMP shows signs of patients misusing opioids; and require states to make PDMP data available to include in an interstate data-sharing system.