PDMP: Friend or Foe to Pharmacists and Patients During the Opioid Crisis?
Written by Anna Haley PharmD’ 22
Published on August 19, 2021
As of June 2021, every state in the United States has developed a prescription drug monitoring program (PDMP), which is a database that collects information on filled controlled substance prescriptions . Many pharmacists regard the PDMP as a positive tool in combating the opioid epidemic; however, what impact does the PDMP have on patients? Both prescribers and pharmacists have access to the PDMP and are required by Pennsylvania law to access it under certain circumstances to monitor and identify misuse and diversion of controlled substances. Furthermore, the PDMP provides objective information and assists the pharmacist in making a more informed decision about dispensing these potentially dangerous medications. Unfortunately, the information provided by the PDMP sometimes leads to the prescription not being dispensed which has the potential to cause patient harm.
Nationally, unintentional drug overdose deaths are up 29 percent in 2020 compared to the previous year amounting to approximately 93,000 deaths. While the number of drug overdose deaths continues to rise, the number of prescribed opioid prescriptions has been declining since 2012. At this point, you may be asking yourself where is the disconnect? If the number of opioid prescriptions is decreasing, how is the number of drug overdose related deaths increasing? In the past five years, there has been a substantial increase in illicitly manufactured fentanyl and fentanyl analogs resulting in a more dangerous illegal drug supply. The CDC reported a 38.4 percent increase in synthetic opioids overdose related deaths from June 2019 to May 2020 and further stated that COVID-19 has accelerated the increase in opioid related overdose deaths. The opioid overdose crisis in the U.S. is a complex and multifaceted public health issue that requires a multi prong approach. The PDMP is one approach to help curb misuse of prescription opioids; however, the PDMP may also be a barrier to a patient’s prescribed medication and inadvertently push the patient to using an illicit opioid.
When a patient with a controlled substance prescription is turned away at the pharmacy due to concerns identified through the PDMP, they may look for other pathways to obtain their medication. Some potential pathways have been identified by The National Survey on Drug Use and Health and include seeking a different pharmacy, obtaining from family or friends (e.g., receiving it for free, purchasing, or taking without asking), and buying from a stranger (e.g., street sources). Finding another pharmacist to dispense the medication can be a difficult and time-consuming task, which may cause further stress and aggravate the patient’s underlying chronic condition(s). When using an alternate pathway, the source may not have the medication needed, or even if they do, it may be adulterated, and potentially result in patient harm. Further, the longer it takes a patient to obtain the medication the closer they are to experiencing withdrawal symptoms. When a patient experiences withdrawal or is in fear of being without their medication they may turn to an illicit pathway. Unfortunately, when a person turns to an illicit pathway to obtain opioids, it’s difficult to know what they are receiving or the potency of the drug, especially with the rise of fentanyl and fentanyl analogs in illicit drug supplies.
For many pharmacists, when they’re deciding to dispense an opioid prescription, they have a responsibility to evaluate the appropriateness of the medication before dispensing it. In some cases, the decision not to dispense the medication may feel like an attempt to combat the opioid crisis; however, not dispensing the medication may have negative patient consequences as well. Failure to provide appropriate counseling or next steps for the patient may lead to patient harm. As a profession, pharmacists need to be educated on how to better utilize the PDMP, consider the long-term effects on the patient, and become better trained on caring for patients with a substance use disorder (SUD). In my next blog, I will discuss how pharmacists can better utilize the PDMP to provide more optimal care to their patients with SUD or at risk of SUD.