Many people do not remember the years before prescription drug monitoring programs (PDMPs) were implemented. Today, 49 states are engaged in some form of tracking prescription drugs and their potential abuse and diversion. Missouri is the only holdout, as it has been unable to get legislation enacted.

The days of pre-PDMPs seem like a bad memory, as we in law enforcement had to work very hard to track down those who were doctor shopping, passing altered or forged prescriptions, or writing illegal prescriptions. My detectives had to travel from pharmacy to pharmacy to look at prescriptions to identify individuals who were shopping doctors and pharmacies and receiving hundreds, if not thousands, of controlled substances.

It was hit-and-miss as to which pharmacy to travel to next, as criminals in Ohio gravitated to not only Ohio pharmacies but ones across the river in Indiana and Kentucky as well. This was tedious work that became easier after we developed a faxing system among cooperating pharmacies. But not every pharmacy checked its fax machine regularly and others did not participate. In addition, in those days, sometimes the fax machine was in the grocery office, not in the pharmacy, so the information often did not make it there. Confidentiality issues were also a problem.

To say that the PDMPs made it easier to track illicit prescriptions would be a huge understatement. When the PDMPs began, the amount of information available was a huge for anyone investigating drug diversion. The obvious other advantage was that dispensers and prescribers had a database that they could access to ensure that a patient was valid and that doctor shopping was not occurring.

Although it took a special request, investigations that involved criminal prescribers were also facilitated by the PDMP. Illicit prescribing and obvious patterns could be tracked and used as an investigative tool or to determine that nothing illegal was transpiring. All this could be done behind the scenes so that no dispenser or prescriber’s reputation was needlessly damaged.

Despite all these benefits, PDMPs are frequently criticized. The most recent attack comes from advocates for patients suffering with chronic pain who claim that the programs unfairly target legitimate patients with pain, sometimes causing their medication to be cut off. If the information is used correctly in the PDMP, that should not negatively affect legitimate patients. However, if the individuals are engaging in illegal activity, their information will show up and prosecutions can result.

Patients with pain, regardless of their situation, are not above the law, and when they doctor shop in desperation, they are subject to charges. I have no doubt that some legitimate patients have been involved in doctor shopping out of frustration of being cut off of or tapered from their opioids by a prescriber who is concerned with potential legal issues.

Other critics question why there is no national PDMP to help track prescriptions across the country. At first blush, this seems like a good idea, as it could potentially help discover illicit activity that is missed in state-only programs.

The problem is that PDMPs in any state are sensitive programs that require oversight, usually by pharmacists, to make sure they are as accurate as possible. Even with tremendous oversight, the possibility of an error exists, such as a drug being incorrect or a patient’s date of birth or name being entered incorrectly. This continuous oversight of the state’s PDMP requires many hours of work by the diligent people in the PDMP’s office. In some cases, thousands, of queries come in each day.

If a federal system is created, even to encompass the 49 states, the bureaucracy of this endeavor is mind-boggling if the system is implemented correctly. In addition to huge operating costs, the chances for multiple mistakes daily could rise to incredible levels, causing the legal system to respond with countless lawsuits that could ultimately shut the whole operation down. I think we would lose this system, if it was not in a state of constant repair. Again, it seems like a worthy project, but as long as we can access our border states, the issue of a doctor shopper committing a crime in Ohio and in Utah is miniscule.

PDMPs are an incredible tool for dispensers, law enforcement, prescribers, and regulatory agencies. Keep the programs in their respective states, and use them sensibly.
 
Cmdr. John Burke is a 40-year veteran of law enforcement, the past president of the National Association of Drug Diversion Investigators, and the president and cofounder of the International Health Facility Diversion Association.