Pain message archives >> February 2009
Oregon 2009 Legislature Seeks Prescription Monitoring Program Bill
Program to Benefit Prescribers and Pharmacies
By Jennifer Wagner
Pain Management coordinator
The non-medical use of prescription opioids by teenagers has increased more than fivefold over the past decade. Diversion from legitimate medical use is the most common source of these abused medications.
The 2009 Oregon Legislature is considering legislation to implement electronic controlled prescription monitoring of controlled substances at risk for misuse. The bill is sponsored by Senators Bill Morrisette (D), Jeff Kruse (R) and Alan Bates (D) and Representatives Ron Maurer (R) and Jim Thompson (R) and also has the backing of the Oregon Pain Management Commission and the Oregon Methamphetamine Taskforce.
Oregon is among the few remaining states not currently running, implementing or enhancing a controlled prescription drug monitoring program (PMP). Thus, practitioners in Oregon do not have a tool to determine if patients are seeking prescription drugs for purposes of abuse or diversion by "doctor shopping" or "pharmacy hopping."
The proposed language of Oregon's PMP would establish a program that electronically collects controlled substance dispensing data from retail pharmacies licensed in Oregon. The data would then be housed in a high security, HIPAA-compliant database within the Board of Pharmacy. PMP will be accessible to physicians or pharmacists who have been credentialed and who agree to HIPAA confidentiality requirements for access to and the use of this information. This program is for use by physicians and pharmacists to monitor patients' medications. It can serve to detect the misuse of prescription drugs and to identify patients who may benefit from a substance abuse referral. It can also serve in an acute care setting to confirm a patient's controlled substance prescriptions. The program will be accessible to prescribers and pharmacies on a 24/7 basis.
Patients who have a legitimate need for controlled substances, but who also engage in aberrant behaviors suggestive of activities such as drug hoarding, drug sharing or self-initiated dose escalation, can be identified through access to PMP data. These patients can be appropriately counseled or can be placed on strict limits intended to normalize their medication use. Once patients adhere to such a medication plan, this can also be verified using PMP.
A PMP report can assure a health care provider that a patient is probably not doctor-shopping. It can restore trust in a relationship threatened by ambiguous patient behaviors that could otherwise cause a doctor to question a patient's honesty or need for a particular drug. Confusion from difficult-to-interpret subjective information provided by a patient to a healthcare provider may be relieved by PMP's objective nature.
The Oregon Board of Pharmacy has received a $350,000 federal grant to support the development and implementation of an online program. Upon legislative enactment, additional funding of $400,000 will be sought. For long-term funding Oregon may replicate other states' programs; the bill's current language favors a modest annual licensing or controlled substance registration fee capped at $25 for all prescribers and dispensers. At this level of funding, Oregon could provide an electronic program available online 24 hours a day, seven days a week. The data would be updated weekly or as often as pharmacies are required to report.
A number of patients express concern over what entities may access their personal data. Kentucky's monitoring program (KASPER) reports that more than 90 percent of queries to its prescription database were from physicians and pharmacists. Only 2 percent were from regulatory boards, and less than 1 percent were from a legally required subpoena with court order. More than90 percent of Kentucky health care practitioners surveyed in 2006 were satisfied with that state's PMP.
The lack of adequate pain management and soaring prescription drug diversion are real public health issues in Oregon. Detecting and better defining addiction and diversion will serve to legitimize the rational treatment of pain with analgesics. Addiction can be treated and diversions prevented. In such an environment, pain can be treated with much less fear that the analgesics are being diverted to non-medical uses.
For more detailed program information, contact Paige Clark, R.Ph., at the Board of Pharmacy at Paige.Clark@state.or.us, or 971-673-0483.