Prescription drug monitoring programs are an essential way to prevent illegal diversion of controlled pharmaceuticals and a keystone in curbing the prescription drug abuse epidemic. PDMPs collect data from pharmacies on dispensed controlled substance prescriptions and make this data available to authorized users, usually by means of a secure, electronically accessible database. In doing so, drug seekers or patients involved in doctor shopping can be readily identified.

In the absence of such monitoring programs, it is far more difficult to flag those who go from one office to the next pretending to maintain a singular clinical relationship with each provider. This behavior is usually motivated by either an addiction problem, an intention to sell the prescription medication on the street or both.

Research has shown that addiction, overdoses and deaths involving nonmedical prescription drug use, particularly narcotic pain medicines, have risen markedly over the last decade. In 2010, drug-related poisonings were the leading cause of death resulting from unintentional injuries in the United States. The number of overdose deaths involving prescription opioids has more than tripled since 1999.

As of July, virtually all states had passed legislation authorizing a PDMP, and 48 states had an operating system. Research and experience indicate that PDMPs serve an essential function in curtailing the prescription drug abuse epidemic. For example, a prospective cost-benefit analysis prior to the launch of the Wisconsin PDMP suggested that the economic benefits of the program would easily exceed the costs of operation and produce savings for the state in health care costs, lost productivity and reduced drug diversion investigation times in excess of $10 million annually.

The Center for Health Policy at the Fairbanks School of Public Health completed a survey of medical providers on awareness and impact of Indiana’s PDMP. Of those who reported that they had changed their prescribing practices in the past year, more than 90 percent noted prescribing fewer controlled substances, and more than 50 percent said that PDMP data was the chief reason for this change.

The Hawaii Prescription Drug Monitoring Program currently monitors Schedule II-IV controlled substances dispensed in Hawaii. Hawaii Revised Statutes, Chapter 329, Part VIII, Electronic Prescription Accountability System is the bill that mandates the Hawaii Narcotics Enforcement Division to maintain an electronic controlled substances prescription database to report dispensed prescriptions for all Schedule II-IV controlled substances under federal law.

This program is making it possible to improve patient care and reduce abuse, and diversion of controlled substances. It is also an excellent tool to facilitate coordination among state, local and federal agencies and other states to minimize abuse and diversion of controlled substances.

The PDMP system is an important tool but by no means the full tool set needed to combat prescription drug abuse. Patients complaining of pain must have a thorough examination and appropriate diagnostic work-up. At Manakai o Malama, chronic pain patients are also asked to sign two pain contracts; the first one requests that patients be open to nonpharmacological treatment options including counseling and physical rehabilitation, while the other is an agreement that prescriptions will be obtained only from this facility and that only one pharmacy may be used to obtain the medication.

Urine drug testing in advance of refills is another key element to a safe and comprehensive program for the management of chronic pain. Providers check to see that the medication prescribed is actually present in the urine. If not, concerns arise that the pills are either being taken too quickly or sold. The urine drug screen is also meant to ensure that no additional drugs that were not prescribed, including illegal substances, are present. If so, there may be dangerous interactions of drugs or drugs and alcohol.

For many years, chronic pain was undertreated because many medical providers were afraid of being singled out for writing these prescriptions. Many were also concerned about the potential for intentional or unintentional overdose and related legal liability. To be sure, over the years, several Hawaii physicians have lost their licenses to practice medicine, and some have served jail time for negligent or illegal practices.

Those with bona fide pain deserve to be treated professionally. Part of every physician’s oath is to serve those in pain. Treatment, however, must be reasonable and appropriate. Proper diagnosis and treatment accompanied by pain contracts for those who will need controlled prescriptions on an ongoing basis is essential. Routine urine drug testing is also a safe practice. The addition of patient drug monitoring programs supports health providers to practice safely in collaboration with colleagues and carriers and, when necessary, law enforcement.

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Ira Zunin, M.D., M.P.H., M.B.A., is medical director of Manakai o Malama Integrative Healthcare Group and Rehabilitation Center and CEO of Global Advisory Services Inc. Please submit your questions to info@manakaiomalama.com.