Explainer: Prescription Monitoring Program Enters Crucial Phase

Andrew Kitchenman | February 11, 2014 | Explainer, Health Care
State considers whether to increase requirements for doctors to participate in PMP

What it is: The New Jersey Prescription Monitoring Program (PMP) is a database established by a 2008 state law and launched in 2012 that collects information on all controlled dangerous substances (CDS) and human growth hormone dispensed to New Jersey residents. All pharmacies are required to submit this information weekly, enabling doctors and other prescribers, as well as pharmacists, to track whether patients are using drugs appropriately.

Why it’s needed: There has been surge of prescription drug abuse, which combined with heroin use, has led to a rise in overdose deaths. Some patients seek prescriptions from multiple doctors to support their own habits or as part of gangs that resell the drugs on the street, while some doctors have worked with organized crime to issue prescriptions.

State officials see the PMP as a tool that can be used to combat this increase in abuse, making it possible for doctors and advanced practice nurses who prescribe CDS — and the pharmacists who dispense them – to know if their patients have been receiving more prescriptions than is appropriate, such as by receiving them from multiple sources.

Low participation: Only 15 of the state’s prescribing doctors and advanced practice nurses actually make use of the database to check if their patients have a pattern of misusing the drugs. This low level of use has been criticized by former Gov. James E. McGreevey and other members of a task force launched by the Governor’s Council on Alcoholism and Drug Abuse. Members of the task force on heroin and other opiate use by young people in New Jersey, including state First Assistant Attorney General Thomas Calcagni, have recommended that all doctors who prescribe dangerous drugs participate in the PMP.

Law enforcement’s push: Criminal investigators and prosecutors have limited access to the PMP. The State Commission on Investigation in a report on prescription drug and heroin abuse issued in July, recommended that law enforcement access to the database be expanded. Instead of having access limited to targeted investigations, subpoenas and court orders, the SCI recommended that law enforcement instead be able to access the PMP as part of broader investigations.

Pushback from doctors: Some doctors, including members of the State Board of Medical Examiners, oppose mandating that all dangerous-drug prescribers check the PMP. They argue that while it may be appropriate to require pain specialists to check the database, most other doctors do not prescribe dangerous drugs in such quantities that their patients are likely to abuse them. For example, emergency room doctors issue prescriptions for limited numbers of painkillers after surgeries. Members of the State Board of Medical Examiners said some doctors would be less likely to prescribe appropriate pain medication to avoid what they see as the bureaucracy of checking the PMP. This could deny patients the pain relief that they need.

The next step: It’s not clear what the final recommendations of the task force on heroin and other opiate use will be — a draft report has been bottled up at the Governor’s Council on Alcoholism and Drug Abuse since last summer, with its release date being pushed back repeatedly. Task force members said state officials told them that the final report wouldn’t be released until GCADA — which currently has an acting executive director and acting chairperson — has permanent leadership.

In addition, state Sen. Joseph F. Vitale (D-Middlesex) has said that changes to the PMP could be included in comprehensive legislation he is working on with other legislators to strengthen prevention, treatment and recovery of opioid addiction.