How Helpful—Or Harmful—Are Prescription Drug Monitoring Programs? – FilterMag.org – by Jackie Rocheleau – April 9, 2019
Before admitting new patients to his practice, Dr. Miguel Diaz checks their prescription history. Diaz, a family medicine physician with Community Care Physicians, PC in Clifton Park, New York, logs onto the state’s prescription drug monitoring program, or PDMP.
There, he sees everything the patient has been prescribed during the past year and who prescribed it.
PDMPs are now being used for all “scheduled” medications, not just opioids, and are made available for perusal by law enforcement and their minions.
Diaz says that when he has come across doctor-shoppers asking for an appointment, “I just didn’t accept them into my practice.”
the SUPPORT for Patients and Communities Actoutlines provisions for expanding PDMPs—electronic databases that physicians, other prescribers, pharmacists and law enforcement can check to track the prescribing of controlled substances, particularly opioids.
Once this piece of the law takes effect in October 2021, physicians in every state will be required to check their state’s PDMP before prescribing controlled substances.
from state to state, “they’re really different in terms of how sophisticated they are, what drugs they cover, how fast they respond, and whether or not physicians are required to check them,” says Keith Humphreys, a professor of mental health policy at Stanford University who advised on the SUPPORT Act.
PDMP Pros and Cons
The expansion of PDMPs is meant to prevent physicians from over-prescribing opioids and encourage responsible prescribing habits
PDMPs can also help physicians identify patients with an addiction, giving them the opportunity to talk to patients about treatment
Described like this, PDMPs sound useful and benign.
But these systems are also used in ways that many advocates, researchers and patients find deeply troubling.
For example, PDMP information can be used to turn away patients with opioid use disorder (OUD)—without offering them resources for addiction. It can also be used to snub chronic pain patients who have a medical need for opioids.
For chronic pain patients, who often take opioids to manage their symptoms, PDMPs are often quite simply a source of anxiety. As Filter has reported, pain patients being cut off from medical care has led to widespread despair and a number of suicides.
“We make decisions whether or not we’re going to accept patients based on what the P[D]MP is showing us,” he says. “You can weed out patients if you need to or want to.”
“We don’t use it as a discriminatory thing,” he says. But at the same time, “I don’t want heroin addicts in my waiting room.”
This fool doesn’t even realize that he negated his first sentence with his second.
If a patient has been flagged by the error-prone PDMP, which can happen because they are legitimately seeing multiple specialists or just using high doses of opioids, he assumes they are addicted and shuns them as “heroin addicts” without any further investigation or concern about the health problem for which they are trying to see him.
I find it amazing that he thinks it’s OK to label patients without seeing or talking to them, no matter their diagnosis, as “heroin addicts” and then believe this is not “a discriminatory thing”.
For patients who are flagged by PDMP screenings, finding primary care may prove nearly impossible.
“That person is essentially blacklisted from receiving healthcare,” Beletsky says.
And Dr. Diaz thinks this is just hunky-dory, patient be damned.
An Acute Lack of Services for Rejected Patients
While current PDMP requirements differ by state, no state trains physicians on what to do when they check the PDMP and find out that a patient has OUD.
Doctors are free to reject patients without
- counseling them on addiction,
- prescribing naloxone, or
- sharing behavioral health resources.
Can a person who rejects needy patients sight unseen still be a “real” doctor?
He sounds more like a willing soldier of the drug-war, repeating the same old tropes about opioids and addiction and jumping to conclusions about opioid users all being “heroin addicts” without giving the person behind the data any consideration at all.
And I just can’t get over that he thinks this is not “a discriminatory thing”.
Maybe he doesn’t know the definition of discrimination because he’s a white alpha male who’s never had a desperately needed resource summarily withheld.
PDMPs have plenty of shortcomings, and will become increasingly controversial as the requirement to check them is rolled out nationwide.
But even with scant resources, physicians can use the PDMP to help addiction patients. When Diaz comes across patients who are addicted to opioids within his practice, he can refer them for Suboxone treatment.
But “the biggest problem,” says Chiarello, “is that we don’t have a strong therapeutic infrastructure for dealing with addiction.”
Jackie Rocheleau is a freelance journalist and editor based in New York. Her writing focuses on public health, medicine and the brain.