Review of Prescription Drug Monitoring Programs in the Unite

Review of Prescription Drug Monitoring Programs in the United States

Kentucky All Schedule Prescription Electronic Reporting Program(KASPER)

Evaluation Team*

Institute for Pharmaceutical Outcomes and Policy

Department of Pharmacy Practice and Science

College of Pharmacy

University of Kentucky

Lexington,Kentucky

June2010

*Karen Blumenschein,PharmD

Joseph L.Fink III,BSPharm,JD

Patricia R.Freeman,PhD,RPh

Kiasha James,MD

Kenneth L.Kirsh,PhD

Douglas T.Steinke,PhD

Jeffery Talbert,PhD

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Introduction

Prescription drug monitoring programs(PDMPs)collect prescription data on medications classified as federal controlled substances.The information is stored in a central database and can be accessed by authorized users.Although programmatic details differ among states,in general,all PDMPs are designed to assist in detecting and preventing abuse,misuse,and diversion of controlled substances.Specifically,programs are targeted toward reducing the incidence of‘doctor shopping’which occurs when patients see multiple providers and pharmacies with the intent of obtaining controlled substances for misuse and/or diversion(1). Health care professionals who prescribe or dispense controlled substances can access PDMP databases with increasing ease and efficiency.Since the advent of electronic prescription drug monitoring systems,access can occur at the point of care and can assist prescribers and dispensers in making treatment decisions.Patients’reported use of scheduled medications can be confirmed by accessing PDMP reports,allowing prescribers and dispensers to detect individuals who may be feigning illnesses in an effort to acquire drugs for the purpose of abuse or diversion.The term prescriber as used in this report includes physicians,dentists,nurse practitioners and other health care professionals authorized to prescribe controlled substances; the term dispenser refers to those individuals who dispense controlled substances,the vast majority of whom are community pharmacists.

In addition to prescribers and dispensers,most states allow regulatory and law enforcement agencies involved in drug-related investigations to access PDMP databases,enabling them to more efficiently collect and analyze data that may be useful in identifying those individuals involved in illegal trafficking or misuse of prescription drugs.

Origin and Funding of Prescription Drug Monitoring Programs

Since the early1930’s,state regulatory,administrative,and law enforcement agencies have seen the need for and have worked to establish systems to track and monitor the prescribing and dispensing of particular prescription drugs.California was the first state to establish a PDMP in1939.By1992,10states had operational PDMPs and many more states were in the process of enacting legislation for the establishment of a PDMP.Although the common goal among these early programs was to reduce prescription drug abuse and diversion,there was wide variation in program design,objectives,and operation.In2002,as part of an effort to standardize and unify PDMPs,the National Alliance for Model State Drug Laws(NAMSDL) drafted a model program,outlining common goals that should be shared among existing and future PDMPs.These goals include:1)detection and prevention of scheduled prescription drug abuse and misuse;2)support of access to controlled substances for legitimate medical use;3)facilitation of the identification and provision of treatment to persons who may be addicted to scheduled prescription drugs;4)utilization of controlled substances use and abuse

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trend data to inform public health and public policy initiatives;and5)education of individuals about PDMPs,and the use,abuse,and diversion of scheduled prescription drugs(2).

With the increasing usage of PDMPs and the steady increase in the abuse and diversion of controlled substances,the Bureau of Justice Assistance(BJA),Office of Justice Programs in the U.S.Department of Justice created the Harold Rogers Prescription Drug Monitoring Program (HRPDMP)in2002(3).Funds for this program were provided by Congress to assist in the planning,implementation,and in some cases the enhancement of state PDMPs.From2002to 2008,over100state HRPDMP grants were awarded by the BJA.For fiscal year(FY)2009,$7 million was appropriated by Congress for the HRPDMP.President Barack Obama proposed that the budget for2010would include$7million for the grant program(4).

A second source of funding for PDMPs is the National All Schedules Prescription Electronic Reporting Act(NASPER)administered by the U.S.Department of Health and Human Services. This program also is designed to assist states in creating a PDMP or enhancing an existing one; however,it differs from the HRPDMP in that it does not provide funding for planning a PDMP (5).During fiscal year(FY)2009,$2million was appropriated by Congress for NASPER implementation.Grants were first made available in FY2009and an additional$2million was proposed by President Obama for NASPER in the FY2010budget(5).

Recommended Components of Prescription Drug Monitoring Programs

According to the National Alliance for Model State Drug Laws(NAMSDL),there are seven key characteristics of a strong PDMP(6).

1.Drugs being monitored should include federal controlled substances and drugs that

have been identified by law enforcement agencies and addiction specialists to have

abusive potential.It is also suggested that some substances,not classified as

scheduled,should be monitored if found to be highly abused,and state legislation

should be passed to place these substances in a schedule.

2.Monitoring systems should proactively provide information to law enforcement

agencies,licensing officials,and other appropriate individuals.This information

should be reviewed by a drug monit …… 此处隐藏：7236字，全部文档内容请下载后查看。喜欢就下载吧 ……