Drug safety experts react to Trump’s plan to build a 'nationally interoperable' PDMP

Part of a plan unveiled by President Donald Trump on Monday to address opioid abuse includes transitioning states to a nationally interoperable Prescription Drug Monitoring Program (PDMP) designed to reduce the number of opioid prescriptions across the country.

Trump’s plan, which aims to reduce the number of opioid prescriptions by one-third over the next three years, is part of a three-pronged effort to stem the opioid epidemic through increased awareness, tighter prescribing practices and a push to prosecute drug dealers with the death penalty.

A nationally interoperable PDMP network that shares prescribing data across state lines is popular among health IT and drug abuse experts that see it as one of several tools to improve data collection and integrate clinical decision support tools.

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“By heeding Health IT Now’s calls for a facilitator model based on National Council of Prescription Drug Programs (NCPDP) standards, this plan can empower clinicians with the tools to stop fraudulent controlled prescriptions before they reach the patient’s hands and to ultimately save more lives from the ravages of opioid misuse,” Health IT Now Executive Director Joel White, who has advocated for a  national data sharing platform, said in a statement.

But several hurdles remain, and drug experts also voiced concern that too much emphasis on PDMPs would distract from more effective solutions.

Although the president’s plan looks to “leverage federal funding” to ensure state transition to a nationally interoperable system, it’s unclear where that money will come from. Currently, 49 states and the District of Columbia have PDMPs and 36 states have laws requiring providers to check those systems before prescribing certain medications, according to data compiled by the National Alliance for Model State Drug Laws.

In 2011, National Association of Boards of Pharmacy created PMP InterConnect, designed to allow states to share prescribing data. Today, 45 PDMPs share data across state lines, according to written testimony from Brad Bauer, senior vice president at Appriss Health, the IT company that helped build PMP InterConnect. Bauer is scheduled to testify before the House Energy and Commerce Committee on Wednesday as legislators review 25 opioid-related bills, including one (PDF) that focuses on PDMP data sharing.

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But those data sharing efforts are often limited to neighboring states. Linda Simoni-Wastila, Ph.D., director of research and policy at the Peter Lamy Center on Drug Therapy and Aging at the University of Maryland School of Pharmacy, who favors a nationally interoperable PDMP, notes that each state system is highly variable.

“In an ideal world, we would understand what components of a PDMP are successful in reducing diversion without compromising appropriate access,” she told FierceHealthcare. “We aren’t there yet—states are all over the map in terms of their ‘rigor’ in applying ill-defined ‘best practices’ and the science evaluating state differences in PDMP implementation and effectiveness is just emerging.”

Caleb Alexander, M.D., co-director of the Johns Hopkins Center for Drug Safety and Effectiveness says PDMPs are “one of dozens of tools that we have to improve the safe use of prescription opioids,” but its far from the most important. A better focus, he argues, would be building in clinical decision support tools ensure prescribers are following CDC guidelines.

A PDMP of the future, which includes more cohesive integration with EHRs, can help facilitate that transition, he adds.

“The value of a PDMP that extends across state lines is going to be large in some areas of the country, and quite small in many others,” he says. “And there is also some value in the current decentralized system, since states can learn from each as they develop and improve their monitoring programs, just as state Medicaid programs provide opportunities for comparisons across state lines.”