Thank you for the insightful article. PDMPs have been proven to be helpful tools (see recent articles by Patrick and Bao in Health Affairs), but they are important to consider in terms of their limitations – they do not detect medication misuse in patients who are diverting meds, for example. However, the best policy is not to treat everyone as “guilty until proven innocent” or even a policy of selective look-ups as clinician gestalt is not great. Simply, consider the PDMP as supplmentary information that should be reviewed prior to any opioid prescription you write. Look it up for EVERY patient for whom you are writing a prescription; don’t allow your biases to assume someone doesn’t have an opioid misuse disorder. You’ll find that if you do it routinely, you’ll be able to obtain the information in <30 seconds. Better yet, technology is making PDMPs integrated into our EMRs, so that the information will eventually be automatically and seamlessly presented. That day isn't here yet, though, but it will come.
I agree, emergency physicians don’t appreciate and don’t need to be told by legislators how to do our job. None of us needs more regulations.
It would be more efficient if the PMP was integrated into the EMR and took only one click to reveal the patient’s controlled substance prescriptions, but requiring that we check a state run website which adds more time, on the order of 2 to 3 minutes, to each patient encounter, is not negligible. Some EMRs can give us a lot of this information, though usually not quickly.
Overall, I appreciate having access to this database, and I use it daily. Anecdotally, I feel like the PMP changes my management in about 1 in 4 cases. It does make me feel like I have a tool to help me not judge the patient. It is somewhat like the pregnancy test: we use it every day, it is quick and cheap, enables us not to judge or always have to believe our patients, and a positive result changes our management.
The well-intentioned three day rule makes it unlikely that I would be compelled to check the database, since I very rarely would prescribe more than three days worth (12-24 tabs) of a controlled substance in the ER. I typically only prescribe 6-12 tabs, to be used when all non-narcotic options have been maximized.
I’m the first one to agree that I don’t like to be told what to do, especially by those who don’t know anything about medicine like the government, but I also feel like the PMP is an excellent tool to help us reduce the risk of prescription (and other) narcotic abuse.
When considering controlled substance abuse potential in the ED, I wouldn’t necessarily consider every patient initially guilty, but a good OB doctor once taught me that every female is pregnant until proven otherwise.
2 Responses to “Prescription Drug Monitoring Programs: Regulatory Burden or an Emergency Physician Function?”
July 28, 2016
Scott WeinerThank you for the insightful article. PDMPs have been proven to be helpful tools (see recent articles by Patrick and Bao in Health Affairs), but they are important to consider in terms of their limitations – they do not detect medication misuse in patients who are diverting meds, for example. However, the best policy is not to treat everyone as “guilty until proven innocent” or even a policy of selective look-ups as clinician gestalt is not great. Simply, consider the PDMP as supplmentary information that should be reviewed prior to any opioid prescription you write. Look it up for EVERY patient for whom you are writing a prescription; don’t allow your biases to assume someone doesn’t have an opioid misuse disorder. You’ll find that if you do it routinely, you’ll be able to obtain the information in <30 seconds. Better yet, technology is making PDMPs integrated into our EMRs, so that the information will eventually be automatically and seamlessly presented. That day isn't here yet, though, but it will come.
August 3, 2016
Rich Greiner, MDRachel, nice article.
I agree, emergency physicians don’t appreciate and don’t need to be told by legislators how to do our job. None of us needs more regulations.
It would be more efficient if the PMP was integrated into the EMR and took only one click to reveal the patient’s controlled substance prescriptions, but requiring that we check a state run website which adds more time, on the order of 2 to 3 minutes, to each patient encounter, is not negligible. Some EMRs can give us a lot of this information, though usually not quickly.
Overall, I appreciate having access to this database, and I use it daily. Anecdotally, I feel like the PMP changes my management in about 1 in 4 cases. It does make me feel like I have a tool to help me not judge the patient. It is somewhat like the pregnancy test: we use it every day, it is quick and cheap, enables us not to judge or always have to believe our patients, and a positive result changes our management.
The well-intentioned three day rule makes it unlikely that I would be compelled to check the database, since I very rarely would prescribe more than three days worth (12-24 tabs) of a controlled substance in the ER. I typically only prescribe 6-12 tabs, to be used when all non-narcotic options have been maximized.
I’m the first one to agree that I don’t like to be told what to do, especially by those who don’t know anything about medicine like the government, but I also feel like the PMP is an excellent tool to help us reduce the risk of prescription (and other) narcotic abuse.
When considering controlled substance abuse potential in the ED, I wouldn’t necessarily consider every patient initially guilty, but a good OB doctor once taught me that every female is pregnant until proven otherwise.