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Reproduced with permission from BNA’s Health Law Reporter, 24 HLR 1135, 8/27/15. Copyright ஽ 2015 by The
Bureau of National Affairs, Inc. (800-372-1033) http://www.bna.com
Why Doesn’t Every State Mandate That Prescribers Check the Prescription Drug
Database?
BY ALIX C. MICHEL AND DAVID J. WARD
A
ccording to the Centers for Disease Control and
Prevention, every year more than 16,500 people in
the U.S. die from prescription opioid-related drug
overdoses, more than the total deaths from heroin and
cocaine combined. Over the past decade, a more than
four-fold increase in opioid overdose deaths paralleled
the four-fold increase in the sales of those drugs, and
the direct health care costs of prescription drug abuse
exceeds $70 billion per year. Tragically, many grieving
family members painfully come to understand that if
the hospitals, doctors and pharmacists who had been
involved in the care of their loved ones had only been
able to identify, in advance, the amount of prescriptions
their loved ones were taking, there could have been an
opportunity for someone to intervene and prevent a
needless death.
Tools Are Available
The truth is that there is an available tool that can
help hospitals, doctors and pharmacists better identify
individuals with prescription drug related issues and
then help tailor that individual’s future medical care
and treatment. That tool is generically referred to as the
‘‘Prescription Drug Monitoring Program’’ (PDMP).
While 49 states have a PDMP in place, less than half re-
quire prescriber registration and mandatory use before
prescribing opioids. The Prescription Drug Monitoring
Program Center of Excellence at Brandeis University
notes that, as of June 2014, the following 22 states had
legislation mandating that prescribers (and in some
cases dispensers) use the PDMP in certain circum-
stances: Arizona, Colorado, Delaware, Indiana, Ken-
tucky, Louisiana, Massachusetts, Minnesota, Missis-
sippi, Nevada, New Mexico, New York, North Carolina,
North Dakota, Ohio, Oklahoma, Rhode Island, Tennes-
see, Vermont, Virginia, Washington and West Virginia.1
How can that number be so low when the CDC has
identified PDMPs as among the most promising state-
level interventions to improve painkiller prescribing, in-
form clinical practice, and protect patients at risk? Fur-
thermore, the measurable data from the states that have
required prescribers to check their PDMPs reflects sig-
nificantly improved public health outcomes.
For example, in 2012, Tennessee required prescribers
to check the state’s PDMP before prescribing painkill-
ers. Within one year, Tennessee saw a 36 percent drop
in patients who were seeing multiple prescribers to ob-
tain the same drugs. Similarly, in Virginia, the number
of doctor shoppers fell by 73 percent after use of the
PDMP became mandatory. The data collected from
New York and Ohio also reflect favorable results in the
fight to curb prescription drug abuse.
While there is no ‘‘silver bullet’’ in the Rx drug battle,
it is not surprising that the experience in Tennessee,
Virginia, New York and Ohio has provided strong
enough evidence for the AMA Task Force to Reduce
Opioid Abuse to recommend the use of PDMPs as one
of its national measures in the fight to curb the pre-
scription drug epidemic. (The AMA Task Force is com-
prised of 27 physician organizations including the
1
See Illustration prepared by the National Alliance for
Model State Drug laws, available at http://www.namsdl.org/
library/99D1512E-C3D3-D54B-1D3DFEF57FE47F77/.
Alix C. Michel and David J. Ward, with Michel
& Ward, Chattanooga, Tenn., have a com-
bined 50 years of legal experience, primarily
in medical and professional malpractice and
prescription drug abuse matters. They can be
reached at alix@michelandward.com and
david@michelandward.com.
COPYRIGHT ஽ 2015 BY THE BUREAU OF NATIONAL AFFAIRS, INC. ISSN 1064-2137
BNA’s
Health Law Reporter™

2.
AMA, the American Osteopathic Association, 17 spe-
cialty and seven state medical societies as well as the
American Dental Association).
Nationwide Application Needed
So why isn’t the use of PDMPs a national
requirement? Some might lay blame for this omission at
the feet of a usual suspect—politics. It certainly has
been cited as one of the reasons for recently stalled ef-
forts in California to mandate/require use of the PDMP
in that state. However, a closer look reveals there are
several hurdles that must be carefully addressed by
each state every time the subject of mandatory use of
the PDMP arises including:
Resource limitations: mandating the use of PDMPs
places an immediate, increased demand on a state’s en-
rollment process/systems and subsequently, on the de-
mand for patient reports. Not every PDMP is suffi-
ciently staffed to handle either need. Advocates for a
mandate must recognize that any mandate will necessi-
tate an expansion and enhancement of PDMP staff and
IT resources to handle the increased enrollment that
will follow as well as the increased demand for reports.
Complaints from prescribers: Invariably, hospitals,
prescribers and local medical groups will raise con-
cerns about the increase in workflow that a mandate to
use PDMPs will cause. Some will argue that increase
will negatively affect wait times, will result in spending
less time with patients, and may also decrease the num-
ber of patients who can be seen within a given time pe-
riod. Some may also claim that a mandate will impinge
on their ‘‘professional discretion.’’ Tennessee was able
to address these concerns by presenting a data-driven
case for the mandate (i.e. citing rising prescription drug
overdoses and deaths) and by modifying its initial legis-
lation to include extenders (i.e. authorized designees)
who could access the PDMP on behalf of a prescriber.
No interconnectivity: Another hurdle arises from the
fact that many PDMPs are not connected to those from
other states. As such, why bother checking if your hos-
pital or office is near another state’s border? Prescrib-
ers cannot see if a patient is obtaining medications from
another prescriber in a bordering state. Fortunately,
this concern is being tackled head on by ‘‘PMP Inter-
connect,’’ a program through the National Association
of Boards of Pharmacy that is working on connecting
PDMPs from various states.2
Conclusion
The important thing is that the early experience of
states like Tennessee, Virginia, New York and Ohio
shows that problems with implementing mandatory
PDMPs can be overcome by working with the medical
community (and other stakeholders) within each state
to build an evidence-based case for its benefits. In addi-
tion, there must be a willingness among the advocates
to negotiate reasonable compromises when crafting
legislation, such that the limitations of each particular
state’s PDMP are properly addressed. If mandatory use
of PDMPs is being heralded as a ‘‘best practice’’ recom-
mendation in the fight against prescription drug abuse,
then what are we waiting for? Let’s get at it.
2
See Illustration prepared by National Association of
Boards of Pharmacy, available at http://www.nabp.net/system/
rich/rich_files/rich_files/000/001/069/original/pmpmap8-4-
15.pdf.
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8-27-15 COPYRIGHT ஽ 2015 BY THE BUREAU OF NATIONAL AFFAIRS, INC. HLR ISSN 1064-2137