Is Hospital ER Weak Link in State’s Prescription Monitoring Program?

Lilo H. Stainton | July 10, 2017 | Health Care
Doctors in emergency room don’t have to check statewide prescription database before they write scrip for opiates

Gov. Chris Christie has made real strides in recent years to strengthen and expand New Jersey’s Prescription Monitoring Program, a database designed to help doctors identify patients seeking inappropriate levels of addictive drugs and reduce the spread of the opioid epidemic.

Now there is interest in a bipartisan proposal to plug what supporters say is a “dangerous loophole” in the program by requiring emergency room providers to also check the system before dispensing certain drugs. Hospital ERs have become a popular spot for opiate-seekers, and several facilities in New Jersey have also taken steps to address this concern on their own.

Emergency room doctors are currently exempt from checking the PMP if they are issuing prescriptions for opioids or similar addictive medicines that last less than five days. (The database predates a law Christie signed in February that restricts all opiate prescriptions for new acute-pain patients to be limited to five days or less.)

Waiting for November

The bill to change the PMP law passed the Senate in late June with unanimous support; the measure awaits a hearing in the Assembly and lawmakers aren’t scheduled to return to Trenton until after the November election.

“Anyone who writes a prescription for a controlled dangerous substance should be required to check the NJPMP before putting pen to paper. It only takes one supply to ruin someone’s life. There can be no exceptions to the laws we have in place to combat the opioid crisis,” said Sen. Diane Allen (R-Burlington).

Allen sponsored the bill (S-3118) introduced in May, with Sen. Jennifer Beck (R-Monmouth) and Sen. Joe Vitale (D-Middlesex), the health committee chairman who has worked to strengthen the database over the years. The Assembly version, sponsored by Assemblymen Daniel Benson (D-Mercer) and Tim Eustace, (D-Passaic)= and Assemblywoman Valerie Vainieri Huttle (D-Bergen), was first unveiled in March.

Some concerns

There is some concern about the bill’s fate in the Assembly, however, since it is next scheduled for a hearing in the lower house’s health committee, which is chaired by Assemblyman Herbert Conaway (D-Gloucester), a medical doctor who has openly opposed laws that create new physician mandates. Conaway also sponsored legislation in 2014 that strengthened the state’s PMP by automatically enrolling prescribers, but the bill did not require physicians to use the system.

Experts have supported the prescription database program as an important tool in reducing access to opiates and other addictive pills; research suggests that a large number of heroin addicts first become addicted to prescription drugs, but eventually shift to illicit options that are often cheaper and easier to obtain.

Such systems are among the protections recommended by the federal Centers for Disease Control and Prevention, which issued a report last week that showed, among other things, how state prevention programs have helped reduce the number of prescriptions issued in recent years. Allen said opioid prescriptions dropped 11 percent between 2013 and 2016, in part because of the PMP.

New Jersey launched its program in 2011 and, while voluntary at first, physicians must now check the records before they dispense opioids and other addictive drugs, classified as Schedule II drugs by the federal government, to first-time patients or issue refills to longer-term users. According to data from the American Medical Association, there were nearly 2.4 million searches conducted last year in the Garden State system alone.

New Jersey’s confidential system now has 73 million entries with patient names and prescription history, and is linked to databases in more than a dozen other states, including New York and Pennsylvania, to help prevent patients from seeking additional prescriptions across the border. Pharmacists also have access to the system and must check it if they suspect abuse.

Allen said it is time to expand the use of the PMP to include hospital emergency departments too; the bill would require all prescribers treating patients there to check a patient’s drug use history before issuing them Schedule II medications. “A person who is suffering from this unbearable disease will understandably stop at nothing to ease their pain. Emergency rooms are open 24 hours a day. It is easy to see why they have become hot spots for doctor-shopping,” she said.

Some Garden State hospitals have taken steps to address this on their own. In early 2016, St. Joseph’s Regional Medical Center in Paterson — home of the state’s busiest ER — may have been the first in the nation to introduce a formal pilot program to reduce the use of opioids by encouraging physicians, and patients, to consider non-narcotic pain treatments instead.