Tracking Prescriptions to Reduce Abuse of Opioids Gains Traction

Andrew Kitchenman | May 15, 2014 | Health Care
But doctors and key legislator oppose mandatory use of central database

Assembly Health and Senior Services Committee Chairman Herb Conaway Jr. (D-Burlington).
The number of people dying from overdoses linked to illicitly obtained opioids has been rising, prompting calls for stricter monitoring to stymie prescription “shopping” by patients.

A bill advancing in the Legislature, A-3129 and S-1998, would automatically register doctors in the New Jersey Prescription Monitoring Program (PMP), a database that tracks all prescriptions for dangerous drugs dispensed to patients in the state.

But the bill doesn’t require that doctors and other prescribers use the PMP every time they prescribe dangerous drugs. This was a central recommendation of a state task force on heroin and other opiate use by teenagers and young adults.

Opiates are drugs derived from opium, while opioids are synthetic drugs whose effect is similar to opiates. The terms are often used interchangeably.

Doctors have strongly opposed the proposed mandate, saying that, while they support the PMP, a mandate would intrude on the practice of medicine and expose doctors to malpractice lawsuits.

There are a number of conflicting bills related to the PMP, but A-3129 is the one most likely to become law because bill sponsor Assemblyman Herb Conaway Jr. (D-Burlington) is chairman of the Assembly Health and Senior Citizens Committee.

The PMP was established by a 2009 law and launched in January 2012. Pharmacists are required by regulations to submit prescription information every week – while the bill would turn this requirement into law, bill sponsors say real-time access to the prescription information would be ideal.

But only 18 percent of eligible doctors and advanced practice nurses in the state have registered for PMP, and state officials said in October that an even smaller percentage is using the program.

Doctors contend that many physicians rarely prescribe dangerous drugs and that mandatory reporting through the PMP could lead some prescribers to reduce access to pain medications for patients who have chronic pain.

But the task force said that voluntary participation in the PMP leads to a “self-selection bias” – only prescribers who are already concerned about prescription abuse are likely to participate.

“Ironically then, some of the professionals who are most in need of the tools that the NJPMP offers – physicians and pharmacists who prescribe painkillers without appreciating the risks and taking steps to control those risks – will tend not to avail themselves of the NJPMP’s monitoring services,” according to a report released in March.

The bill would automatically register doctors and advanced practice nurses in the PMP when they file their annual license renewal. It also would allow prescribers to designate other licensed healthcare professionals to access the database.

Conaway said doctors are concerned that mandatory participation will lead to the law being rewritten every time there’s a change in medical standards, and that there could be lawsuits filed whenever a doctor didn’t use the program.

“There is a lot of concern about the medical liability system in which we operate today, and we’re going to be very concerned about anything which would make that liability even worse,” said Conaway, a family doctor.

The bill also doesn’t include a recommendation — made in a State Commission of Investigations report released last summer — that law-enforcement officials have easier access to the PMP.

Instead, Conaway said, doctors want to make sure that patients are able to check whether their prescription records were improperly accessed. Conaway said that is one of several amendments he wants to add to the bill, including adding the opioid tramadol to the list of drugs tracked by the PMP.

“You can’t defend your right to privacy if you don’t know if someone has accessed your record,” Conaway said of patients’ ability to check who has accessed their records.

A bill that would add a PMP use mandate, A-3007], and another that would increase law-enforcement access to the PMP program, A-3008, have been introduced, but haven’t been scheduled for a hearing by Conaway’s committee.

Both measures were unanimously opposed by the State Board of Medical Examiners yesterday. Board members said doctors’ participation should be voluntary.

Having prescription information instantly added to the PMP remains more of an aspiration than a reality.

As recently as December, it was taking the state upwards of 60 days to upload prescription information, according to John Holub, executive director of pharmacy trade group the New Jersey Council of Chain Drug Stores, a trade group.

It’s not clear what the current upload time is, since the state recently upgraded the PMP software.

The Medical Society of New Jersey – the state’s largest doctors’ group – has been providing training to doctors about the best practices for reducing prescription abuse, according to society Chief Operating Officer Mishael Azam. While the society supports the program, it opposes a mandate.

Both Azam and Conaway underscored the importance of providing better access to addiction treatment.

“I would like to make sure that the insurance policies will cover these (addiction) issues so that people have a place to go,” Conaway said during a May 8 committee hearing at which the bill was released by a unanimous vote.

The Senate version of the PMP bill hasn’t been scheduled for a committee hearing yet. Sen. Joseph F. Vitale (D-Middlesex) has said that he plans to work with other lawmakers to introduce additional legislation on drug prevention, treatment and recovery.