By Brendan Abel, JD, MMS Legislative and Regulatory Affairs Counsel
Prescription monitoring programs (PMPs) are undergoing a revamp in their role in clinical care — becoming less a checkbox dictated by law, and more a vital piece of the standard of care in the prescribing of many controlled substances.
PMPs have become ubiquitous across the country. For some time, tracking opioid prescribing was discussed in the context of providers meeting their obligation to administrators at the Massachusetts Department of Public Health (MDPH). But the role of PMPs is expanding as physicians seek to meet patients’ pain treatment needs in the context of the opioid epidemic, and as medical and legal stakeholders — including licensing boards, courts, and legislatures — pay closer attention to the standard of care of prescribing.
Improving Clinical Practice
The PMP has broadened the clinical expectations of prescribers, and has become a tool for informing conversations with patients and clinical decision making. For example, prescribing an opioid to Patient X may seem appropriate given the patient’s clinical presentation. But information from the PMP — such as Patient X’s other opioid or high-dose benzodiazepine prescriptions — could bring the appropriateness of the new prescription into question. The implications go beyond noncompliance to the possibility of substandard care.
Dennis Dimitri, MD
The recent death of singer Tom Petty helps demonstrate the clinical value of the PMP, says Dennis Dimitri, MD, chair of the MMS Task Force on Opioid Therapy and Physician Communication. “Medical examiner reports indicated presence of multiple opioids, benzodiazepines, and antidepressants in his blood stream. All may have been legitimately prescribed by different doctors for the several conditions (broken hip, depression) that Petty suffered. If the PMP was not being regularly checked, it is possible that various treating physicians may not have been aware of the dangerous combination of medications.”
The Medical Society urges all physicians to become familiar with the PMP laws and regulations in Massachusetts (
more information), and to find systems and processes to incorporate PMP use into clinical practice. In 2014, the MMS House of Delegates recognized the need to facilitate physician communication about opioid prescribing for the same patient: “Regular utilization of the PMP is one of the solutions to that communication gap,” says Dr. Dimitri, a past president of the MMS.
Enforcing PMP Requirements
The Medical Society strongly supported the 2016 transition to the Massachusetts Prescription Awareness Tool —
MassPAT — with its improved functionality and ease of access. Prescribers have responded to increasing statutory requirements to use the system. Now, they are required to query the system prior to every Schedule II and III narcotic prescription, and before a patient’s first benzodiazepine prescription.
The importance of providers’ compliance with the PMP is emphasized by the Medical Society, health care administrators, and lawyers. Warnings to prescribers have often referenced potential enforcement actions by the MDPH. This advice holds true. The MDPH and its Medical Review Group have the authority to refer concerning cases to appropriate licensing boards, and the MDPH could revoke prescribers’ Massachusetts Controlled Substances Registration, which is necessary for prescribing.
The Board of Registration in Medicine has referenced PMP usage when considering whether to suspend physicians’ licenses. Malpractice cases are increasingly citing PMP use an element of compliance with the standard of care. With all of these changes, proper usage of the PMP continues to be a vital component of clinical practice.
