In the midst of national concern over illicit drug use and abuse,
prescription drug abuse has been identified as the United States'
fastest growing drug problem. Nearly all prescription drugs
involved in overdoses are originally prescribed by a physician
(rather than, for example, being stolen from pharmacies). Thus,
attention has been directed toward preventing the diversion of
prescription drugs after the prescriptions are dispensed.
Prescription drug monitoring programs (PDMPs) maintain statewide
electronic databases of prescriptions dispensed for controlled
substances (i.e., prescription drugs of abuse that are subject to
stricter government regulation). Information collected by PDMPs may
be used to support access to and legitimate medical use of
controlled substances; identify or prevent drug abuse and
diversion; facilitate the identification of prescription
drug-addicted individuals and enable intervention and treatment;
outline drug use and abuse trends to inform public health
initiatives; or educate individuals about prescription drug use,
abuse, and diversion as well as about PDMPs. How PDMPs are
organized and operated varies among states. Each state determines
which agency houses the PDMP; which controlled substances must be
reported; which types of dispensers are required to submit data
(e.g., pharmacies); how often data are collected; who may access
information in the PDMP database (e.g., prescribers, dispensers, or
law enforcement); the circumstances under which the information may
(or must) be accessed; and what enforcement mechanisms are in place
for noncompliance. States finance PDMPs using monies from a variety
of sources including the state general fund, prescriber and
pharmacy licensing fees, state controlled substance registration
fees, health insurers' fees, direct-support organizations, state
grants, and/or federal grants. The federal government has
established two grant programs aimed at supporting state PDMPs: The
Harold Rogers PDMP grant, administered by the Department of
Justice, and the National All Schedules Prescription Electronic
Reporting Act of 2005 (NASPER) grant, administered by the
Department of Health and Human Services. State PDMPs vary widely
with respect to whether or how information contained in the
database is shared with other states. While some states do not have
measures in place allowing interstate sharing of information,
others have specific practices for sharing. An effort is ongoing to
facilitate information sharing using prescription monitoring
information exchange (PMIX) architecture. Legislation has been
introduced in the 112th Congress that would take up these issues.
The available evidence suggests that PDMPs are effective in
reducing the time required for drug diversion investigations,
changing prescribing behavior, reducing "doctor shopping," and
reducing prescription drug abuse; however, research on the
effectiveness of PDMPs is limited. Assessments of effectiveness may
also take into consideration potential unintended consequences of
PDMPs, such as limiting access to medications for legitimate use or
pushing drug diversion activities over the border into a
neighboring state. Experts suggest that PDMP effectiveness might be
improved by increasing the timeliness, completeness, consistency,
and accessibility of the data. Current policy issues that might
come before Congress include the role of state PDMPs in the federal
prescription drug abuse strategy and the role of the federal
government in interstate datasharing and interoperability. While
establishment and enhancement of PDMPs enjoy broad support,
stakeholders express concerns about health care versus law
enforcement uses of PDMP data (particularly with regard to
protection of personally identifiable health information) and
maintaining access to medication for patients with legitimate
medical needs.
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