Much has been written about prescription opioid abuse, and with good reason – it has reached epidemic proportions in the United States. One of the biggest challenges associated with opioid abuse is ensuring that patients with a legitimate need for the medications can access them, while preventing those who abuse or divert the drugs from obtaining them.
With a national spotlight on the problem, public awareness continues to grow. A recent survey by CVS Health shows the public agrees that pharmacists can help reduce prescription drug abuse by using their knowledge and professional judgment. In fact, pharmacists from across our enterprise are trained in identifying patients who are at risk for abuse or inappropriate use of controlled substances. Our pharmacists are empowered to refuse to fill prescriptions they feel are not being used for legitimate medical purposes.
Technology can also help. Prescription drug monitoring programs (PDMPs) are statewide electronic databases that gather information from pharmacies on prescriptions for controlled substances, including opioids, that have been dispensed. They allow both pharmacists and prescribers to review prescription histories for signs of abuse or diversion, and can help prevent unnecessary prescriptions from being written in the first place. The data can also provide a useful starting point for getting patients who are struggling with prescription drug abuse on the path to treatment for addiction.
While PDMP technology is currently available in 49 states, its scope is somewhat limited. For example, providers in many states can only see information for the state in which they practice, not for all states where a patient may have been prescribed medication. And although PDMPs have been identified by the White House Office of National Drug Control Policy as an important tool in fighting prescription drug abuse, utilization rates are suboptimal. In most states, health care professionals are not required to review PDMP information, and the process of accessing data is time-consuming, leading many to skip this step altogether1.
CVS Health is working at the federal and state level to implement policy changes to curb prescription drug abuse. Our recommendations include:
- Mandatory utilization of Prescription Drug Monitoring Program (PDMP) data at the point of prescribing would require prescribers to review the patient’s pharmacy prescription history, showing the prescriber whether the patient is doctor shopping (using more than one prescriber to obtain controlled substance prescriptions).
- PDMP data pushed directly to the prescriber’s e-prescribing device would give the provider instant access to the patient’s history before deciding whether the medication is for a legitimate medical purpose.
- PDMP interoperability across state lines would allow prescribers full visibility into patient prescription fill patterns and reduce or eliminate doctor and pharmacy shopping that occurs across state lines. PDMPs can currently share data across state lines in 22 of the 49 programs.
- E-prescribing for controlled substances has proven to be effective in reducing drug diversion and fraud.
- Daily PDMP data submission from pharmacies to the state database will ensure that each database is accurate and encourage use by reducing lag time between updates.
CVS Health is fully committed to the fight against prescription drug abuse, and has been actively engaging members of the health care community in robust discussions about the issue.
1 The Pew Charitable Trusts. Improvements to Prescription Drug Monitoring Programs Can Help Stop Overdose Deaths (2016).