Delaware officials tout prescription monitoring oversight

DOVER — A pharmacist logs onto his computer to check a painkiller prescription for a new patient. With just a few clicks, the pharmacist can see the patient has recently received similar medications from three other pharmacists. Suspecting the patient has been doctor shopping to score pills, the pharmacist makes a few phone calls.

In almost no time, health officials and advocates have reached out to the patient, offering assistance and advice in fighting addiction.
It’s all possible thanks to the state’s Prescription Monitoring Program, one of many tools in the fight against the opioid epidemic.

Created in recent years as overdose deaths have shot up, the PMP serves as a valuable resource for both doctors and pharmacies, to say nothing of health officials.
The PMP is, in the words of Division of Professional Regulation Director David Mangler, “a database that captures all of the controlled substance prescriptions that are filled by a pharmacy” and picked up by a patient.

Pharmacies must upload prescription information, including the prescriber, the drug and whether it was paid for by insurance, every 24 hours, making the database “almost near-real time,” Mr. Mangler said. The PMP’s regulations apply to all pharmacies licensed in the state.

A report released last month by the Department of Health and Social Services offers a tantalizing glimpse at some of the information contained within the PMP.
According to an analysis of the 343 Delawareans who overdosed in 2017, 164 had a prescription in the PMP in the year prior to their deaths.
Eighty-one of those had a prescription for an opioid.

It’s not difficult to see how that sort of breakdown could help health experts identify and catch those who otherwise might overdose — stopping the problem at the source.

Created in 2012, the PMP received an upgrade in 2017 when the vendor responsible for the database was sold to another company.

Essentially, the changes made the database much simpler to use, offering more details while requiring fewer clicks — previously a major annoyance for users, according to Mr. Mangler.

The PMP not only helps doctors and pharmacists catch individuals who might be doctor shopping, it enables them to more easily spot medications that could conflict or indicate an addiction.

“Theoretically, what prescribers are supposed to be looking for: I really don’t know you and I’m going to prescribe something for you and I go to the PMP. Are you getting prescriptions from somebody else? When was your last prescription? Are there other controlled substances that are going to interact badly if I’m going to write for an opioid — things like that,” Mr. Mangler said.

One tell, for instance, can be whether the patient paid for the medication with cash. An astute doctor or pharmacist could pick up on that, surmising the customer pays cash because insurance won’t pay for several kinds of the same medication, and deny the request.

Depending on the medications and indicators (such as receiving opioid prescriptions from at least five different places in one year), the PMP assigns patients a risk score. That seemingly simple numeric value tells doctors and pharmacists crucial information, information that can even be life-saving.

Because it’s intended “primarily as a patient care tool for prescribers,” according to Mr. Mangler, the PMP itself contains guides for health care professionals on how to best utilize its features. Among the webinars available is information explaining exactly what the risk score means and providing context for providers unfamiliar with the system.

The state has used federal grant money to improve the database as well, working with the Division of Public Health to make changes to better suit its users. Because of legislation passed by the General Assembly, different agencies can share data for the PMP, enhancing its effectiveness, Mr. Mangler said.

The PMP receives recommendations from an advisory committee, which is also responsible for creating metrics to spot patterns in opioid dispensing and prescribing and has the power to report individuals to the Division of Professional Regulation for investigation. Those metrics, like much of the data and work associated with the PMP, are not public.

Delaware shares data in the PMP with 34 other states, as well as the Department of Defense, and plans to soon add the U.S. Department of Veterans Affairs — all part of the integrated system that helps officials recognize and respond to problems as quickly as possible.

The PMP plays a role in another state regulation created in response to the opioid crisis: the seven-day prescription limit adopted in 2017. However, doctors do have the ability to provide a supply that exceeds a week as long as they first use the PMP to review patient information and judge whether it is safe.

The state has seen a decrease in total opioids of about 16 percent under the restriction, Mr. Mangler said.
But despite those steps, there’s a long way to go, as just about anyone who works in substance abuse can attest. And while the Prescription Monitoring Program is a valuable tool, it’s just one part of the solution, which must also involve education and coordinated treatment services available to all.

“Over the past year we’ve really started to seal the gaps in the sidewalk, those fragments,” said Lt. Gov. Bethany Hall-Long, who chairs the Behavioral Health Consortium.

And that’s something the PMP can help with.
When the state shut down Patrick Titus’ Milford practice in 2014 in response to the doctor allegedly giving out prescriptions for pain pills without cause, the Division of Pro Regulation was involved in the response.

The state tried to inform patients about treatment efforts, seeking to offer education and a helping hand instead of criminal penalties.

Because of concerns that shutting down a doctor for improperly prescribing medications will just drive many patients to buying drugs off the street, the state uses the PMP to help attack the problem early. Before it shuts down a physician, the Division of Professional Regulation goes through the database to identify individuals who would be impacted by the closure, Mr. Mangler said.

The state then notifies local police, hospitals and pharmacies to ensure they are ready for a possible surge and contacts the Medical Society of Delaware as well. It will even roll out mobile units if need be, according to Mr. Mangler.

The crisis, officials emphasize, impacts everyone.
“The opioid epidemic doesn’t have one cause and there’s not one face to the epidemic,” Lt. Gov. Hall-Long said. “It affects all communities, all zip codes.”

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