The ongoing fight to establish a program to track opioid prescribing in Missouri has once again raised discussion on whether the country would be best served by a national monitoring system.
Missouri remains the only state in the country without a prescription drug monitoring program, which collects information to warn physicians that they may overprescribe opioids and prevent a patient from seeking prescriptions from multiple physicians.
Republican Missouri state Sen. Rob Schaaf, a family physician and a longtime opponent of drug monitoring programs, introduced a bill that would allow a physician to view a patient's medical data only when the state's health department identified cases of doctor-shopping. Critics of the bill say the measure is added work on physicians.
Supporters contend a national program expands and streamlines the information available.
“I think that there wouldn't be anyone who would disagree with the idea that it would be better to have a single national system rather than all of these different state systems,” said Dr. Andrew Kolodny, co-director of Opioid Policy research at Brandeis University's Heller School of Social Policy and Management.
Kolodny said a uniform national system would solve the inability for a state to track interstate drug trafficking. State PDMP systems often differ in the technology they use, as well as the rules and regulations by which they operate. Also, state PDMPs differ on the frequency in which data is collected.
But the move toward establishing a national monitoring program has never gotten off the ground because critics feel states may lose the flexibility they need to address their specific drug problems.
“Each of these programs, in doing something different, they also do a lot of innovative things,” said Peter Kreiner, a senior scientist at the Schneider Institute for Health policy at Brandeis University. “If you had a national program you could imagine the kind of bureaucracy that would be associated with that, and it's unlikely it would be able to innovate in nearly the way state programs can.”
But according to Tom Bizzaro, vice president of health policy and industry relations for health data firm First Databank and a longtime supporter of a national PDMP network, states would be able to keep their individual regulations and rules under a national network by using standards that are already in use by pharmacies for claims reimbursement and electronic prescribing.
“The infrastructure is there,” Bizzaro said. “So we're not talking about having to create a pipeline for that information; that already exists.” Bizzaro said using that infrastructure allows for states to determine who has access to their PDMP, the kind of information that is shared, and what types of drugs would be included.
A total of 41 states engage in some form of interstate data-sharing. But most sharing is still done on a regional basis among a bloc of a few states. A physician in California may be able to easily find that a patient was prescribed opioids in Oregon, but they would not have clue as to whether the same patient recently received a prescription for pain relievers in New York or Illinois.
Supporters of a national PDMP program believe it would only make it easier for interstate data-sharing to take place. But it could also attract hackers.
“The bigger a database gets the more practical concerns there can be about data security and the ramifications of hacking,” said Nathan Freed Wessler, a staff attorney with the American Civil Liberties Union's Speech, Privacy, and Technology Project. “There may well be benefits in terms of efficiency, but in this area, I don't think the efficiency is the most important value.”
Still others feel the whole premise of a national PDMP may be outdated considering current trends in drug use. The rate of overdose deaths by prescription pain relievers has been leveling off over the past few years while deaths from heroin have skyrocketed, from 8% of all drug overdose deaths in 2010 to 25% by 2015, according to the Centers for Disease Control and Prevention.
“The drug problem keeps changing, keeps morphing, and keeps staying ahead of the efforts to address it,” Kreiner said. “Having a slow-moving entity that's trying to help address it probably not a great idea.”
The attention that's been given toward prescribing practices involving opioids over the past few years has led to a reduction in prescriptions. That may have led addicts to switch to heroin as prescription medications become sparse.
“It seems like the ship may have already sailed on that,” said Bryce Pardo, a drug policy analyst with research and consulting public policy firm, BOTEC Analysis Corp, referring to the database helping curb the overdose epidemic. “It seems like the market is shifting toward heroin, so it seems like we're entering the second stage of this epidemic.”
But Kolodny said the CDC figures do not provide an accurate portrait of what is truly happening in terms of the epidemic. He said the switching from pain relievers to heroin occurred early in the drug epidemic predominantly among younger adults, but prescription opioids remain a large concern among older Americans.
Bizzaro believes there will someday be a national drug monitoring program and he's gauging the Trump administration's interest in developing one.
“I think it just makes too much sense to have a national program,” Bizzaro said. “I see it now as more of a political issue than a technical one.”