A Diagnostic Tool
In Kentucky, doctors and some patients complained about the requirement when it was first adopted, Ingram said. But these days, he said, he mostly hears doctors saying, "Wow, I treated that patient for 20 years and had no idea he had a drug problem."
"If there’s a tool out there that takes 15 seconds to use and can diagnose a disease, why wouldn’t you want to use it? To me it's a no brainer," Ingram said.
Before Kentucky physicians were required to check the database, patients commonly visited multiple doctors to get prescriptions for opioid painkillers, the sedative Xanax, and the muscle relaxant Soma, according to the state's PDMP director, David Hopkins. "The cocktail," as it's known in Kentucky, produces a high that is similar to heroin and just as deadly. It has become much less prevalent since the law was enacted.
"We cracked down on that big time," Hopkins said. The number of people receiving the cocktail has dropped 30 percent since the law took effect and the number of doctor shoppers has dropped 52 percent, he said.
Kentucky is also trying to curtail dangerously high doses of prescribed painkillers by flagging the database when a patient is taking medications from multiple sources that add up to the equivalent of 100 milligrams or more of morphine per day. Last year, a calculator was added to the system so doctors wouldn’t have to add up the morphine equivalents on their own.
Hopkins said the state listened to doctors’ complaints and added some commonsense exceptions after the initial rules came out. Prescribers are no longer required to check the database in emergencies or for patients in hospice, long-term care or cancer treatment. They can also skip the step if a patient was originally prescribed a pain medication by a fellow doctor in their practice and needs a refill or a different pain medicine.
Kentucky's prescriber rules, which were developed by the state Board of Medical Licensure, allow doctors to appoint a delegate to access the drug monitoring system and review patients' drug profiles. Doctors typically ask their assistants to run prescription drug histories on all the patients they will see the next day and add the information to their electronic medical records, said Michael Rodman, director of Kentucky's licensure board.
If a potential drug problem is detected, prescribers can query the database to determine how other physicians in the state are addressing the pain needs of similar patients and they can discuss an individual patient's drug history with another prescriber, something that was forbidden under previous state privacy laws.
Another part of Kentucky's 2012 opioid law requires prescribers to attend a certain number of free training sessions each year on addiction, pain management and use of the state's prescription monitoring system. (Jones conducts some of those training programs.)
To increase the effectiveness of drug monitoring programs, Kentucky and other states use reciprocal agreements to allow interstate sharing of drug dispensing information for pharmacists, law enforcement and physicians in nearby states. Kentucky has agreements with at least 20 other states. New Jersey Gov. Chris Christie, a Republican, announced in April that New York had joined his state in sharing PDMP information, along with Connecticut, Delaware, Minnesota, Rhode Island, South Carolina and Virginia.
As for what happens when a physician discovers a patient is doctor shopping, Rodman said, they often dismiss patients and no longer treat them.
But Jones, who heads the Kentucky Physicians Health Foundation, which supports doctors who suffer from substance use disorders, tells doctors not to do that to patients.
"Maybe you don't keep prescribing them 90 OxyContins with five refills," he said, "but don't throw them out. If you do, you're missing an important opportunity to save a life."
*The Pew Charitable Trusts is driven by the power of knowledge to solve today's most challenging problems. Pew applies a rigorous, analytical approach to improve public policy, inform the public and invigorate civic life.
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