Marc L. Fleming, PhD, MPH, RPh, is an Assistant Professor in Pharmacy Administration and Public Health, within the Department of Clinical Sciences and Administration at University of Houston, College of Pharmacy. He has been involved in pharmacy practice for over 15 years: 11 in chain pharmacies and 4 in hospital.
His primary research focus is prescription drug abuse with a particular emphasis on physicians’ and pharmacists’ use of the prescription drug monitoring program (PDMP) to curtail prescription drug abuse, with the long term research goal to develop education to help pharmacists address patient’s prescription drug addiction. He recently published a paper titled: ‘Prescribers and Pharmacists Requests for Prescription Monitoring Program (PMP) Data: Does PMP Structure Matter?’ in the Journal of Pain & Palliative Care Pharmacotherapy.
Background of the study
I began researching prescription drug monitoring programs after hearing an entertainment reporter talk about the need for such databases following the death of Heath Ledger. I wondered why I had not heard about these databases as a practicing pharmacist. This interest led to my dissertation topic to examine Texas pharmacists’ intention to utilize a PDMP.
Many states provide online access to PDMP or prescription monitoring program (PMP) (these 2 terms are used interchangeably). Basically a doctor or pharmacist can log into a password protected website and enter patient information and get a report which details the patient’s controlled substance medication use. Some programs do not allow online access to doctors or pharmacists such as the case in Pennsylvania. Therefore, healthcare practitioners are not able to look up a patient’s information and thus may not have an opportunity to intervene with a patient to prevent continued prescription drug misuse or abuse. Additionally, some states only monitor drugs classified by the Drug Enforcement Administration (DEA) as Schedule II-most addictive (e.g., Oxycontin®) to Schedule IV (e.g., Xanax®). These PMPs will not have data on promethazine with codeine, which is known as “syrup” on the streets and glamorized in rap music. The DEA Schedule for promethazine with codeine is V, therefore patients abusing this drug, will not have this information available in the states’ PMP database where only Schedule II to Schedule IV are monitored.
The best way to think of PMPs is an electronic prescription record for controlled substance prescriptions used by patients in their respective states. These databases do not contain information from inpatient hospital stays. They only collect data from outpatient pharmacy settings such as typical retail chain or independent pharmacies. However, some states are now sharing PMP data with their bordering states.
State PMPs should be striving to provide the most efficient and user friendly database to doctors and pharmacists. The easier the programs are to use, the more practitioners will utilize the data to help patients, and thus be able to save lives. The funding associated with maintaining PMPs seems small in light of the current epidemic and related deaths and emergency room visits associated with prescription drug abuse. Money spent to make PMPs user friendly, and efficient is necessary for doctors and pharmacists to see them as not disrupting practice or taking up a significant amount of time to use. Time is very precious in medical practice and the less time it takes to review a patient’s controlled substance medication profile, the more doctors and pharmacists are likely to appropriately use PMPs.
I am continuing to focus my research efforts on PDMP use in Texas. The Texas PDMP was made available to doctors and pharmacists in August 2012. I have conducted research to examine emergency department physicians’ use of the Texas PDMP. The next steps are to understand how many prescribers (which include doctors, nurse practitioners and physician assistants) and pharmacists are using the PDMPs and more importantly, how they use the data to make decisions on prescribing and dispensing. For instance, is examining data over a course of a year more appropriate than examining data in the past three months?
States must focus resources to educate the public via media campaigns and work with boards of medicine and pharmacy to create continuing education programs aimed at enhancing knowledge and awareness of PDMPs. Additionally, states can mandate registration by prescribers and pharmacists. Some states such as Kentucky and New York have implemented mandatory use of their state PDMP in specific situations, such as first time doctor visits.
About the department
The Division of Pharmacy Administration and Public Health in the Department of Clinical Sciences and Administration at the University of Houston, College of Pharmacy consists of seven core faculty members. The division provides graduate training and conducts research in the areas of pharmaceutical health outcomes and policy. The divisional research focuses on quantitative observational methods mainly based on administrative healthcare data like electronic medical records and pharmacy claims. The divisional faculty members also have expertise in practice-based experimental research involving (survey design) social behavioral theories to address critical issues in pharmacy and medical practice.