Why You Need to Know About the New Prescription Drug Monitoring Act

Why You Need to Know About the New Prescription Drug Monitoring Act, Lynn R Webster, MD, @LynnRWebsterMD,

Minnesota Sen. Amy Klobuchar co-introduced the Comprehensive Addiction and Recovery Act (CARA) which was signed into law by President Obama last month. Now she’s co-introduced the Prescription Drug Monitoring Act which would mandate that doctors use prescription drug monitoring programs when prescribing painkillers to a patient for the first time.

What are Prescription Monitoring Programs (PMPs)? 

Prescription monitoring programs (PMPs) create a central repository of prescription records. The information is stored in online electronic databases that allow easy access to authorized individuals or agencies such as law enforcement and drug control agencies, practitioner licensure boards, medical examiners, drug courts and criminal diversion programs, addiction treatment programs, public and private third-party payers, medication dispensers (e.g., pharmacies) and prescribers, and other healthcare providers.

Access to the PMPs varies by state. Providers are always able to access information about their patients, but it is illegal to search for information on other people. In some states, law enforcement has easy access while, in other states, law enforcement can only obtain the records with a subpoena.

Advantages of PMPs

PMPs can identify the high prescribers of controlled substances. That gets into the issue of how much medication is too much for doctors to prescribe. While it’s good to have a system of checks-and-balances in place, it would be unfortunate to see law enforcement empowered to access personal medical data based on what might be in the PMP.

PMPs can help address a serious opioid problem, unless PMPs become impractical, burdensome, too costly, or inaccurate. They can detect people who are diverting drugs or “doctor shoppers.” This could have a public health benefit, but it could also be a threat to personal liberties and, potentially, it could expose personal medical history to non-medical personnel.

Sen. Klobuchar cites the story of a doctor “who claimed to have a patient who obtained 108 different prescriptions from 85 different doctors in the Upper Midwest.” This an egregious and rare example of what one can find by using a PMP, but it is not uncommon to discover a patient receiving controlled substances from several providers at the same time. This is not necessarily improper, but it should raise a red flag for the provider and lead to an investigation into the reason by the provider.

Combining different prescription (with or without adding over-the-counter medications and alcohol to the mix) drugs can be fatal, as we saw in the cases of Anna Nicole Smith, Whitney Houston, Heath Ledger, and too many others. However, I doubt prescription monitoring programs would have prevented these overdoses, because there is no evidence they were doctor shopping. Remember, Rush Limbaugh bought the painkillers he needed to feed his addiction illegally. Black market purchases are not going be detected with prescription monitoring.

Prescribers can also proactively use the database to identify individuals who may unknowingly be using concomitant medications prescribed by different providers that could be dangerous when taken with an opioid. This provides an important benefit, since patients may not report complete information in their health history.

Challenges of PMPs

In fact, there are many advantages to PMPs. However, prescription monitoring does not prevent the disease of addiction. Preventing addiction and treating addiction require much more. PMPs are not a solution to the addiction crisis. They are a tool in detecting who may have a problem, but they are unlikely to prevent addiction. For more information about PMPs, see my piece on Brainblogger.

Yes, PMPs could lead to interventions for those with a substance use disorder. If that is to work, we must have affordable treatments available for people who need it if, and when, they are identified. That is where we should put our focus.

PMPs show a great deal of promise and can do much good. But, they are only a tool to address a small part of the prescription opioid problem. They will do nothing for the exploding heroin and synthetic drug problem. Let’s not overstate their value, but acknowledge and support the contribution they can make in our fight against prescription drug abuse and diversion.

Purchase my book The Painful Truth: What Chronic Pain Is Really Like and Why It Matters to Each of Us (available on Amazon) or read a free excerpt here.

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Copyright 2016, Lynn Webster, MD


  1. Kenneth Mckenna on August 20, 2016 at 7:34 pm

    I’ve never had an issue of any kind in the 13 years I’ve been treated with opioids. it’s made my doctor realize I do not go elsewhere for any R.Xs. Being the VA is a government entity, the CDC’s guidelines are followed to a T. At first I thought the P.M.P and drug tests were gonna be a pain in my butt, however now I see where it’s necessary to allow my doctor to show the powers that be,
    that we are both compliant. This can be an advantage for both of us. When the guidelines first came out many physicians got a bit overzealous, dropping doses way to quickly. My pain mngmnt
    Doc wanted to taper me very slowly and needed to show superiors that I was being compliant, and cooperative in my healthcare plan. By using the PMP and other compliance tools my doctor was able to do just that. So the things I thought were a pain in my butt actually ended up helping me immensely.

  2. Alta Hanlon on August 21, 2016 at 2:35 am

    I believe addicts are born and not made. I have been taking opioid meds for 9 years without incident. Before being prescribed a narcotic, I had already tried everything else except surgery which may not fix my problem. My 5 yr old sister was found unconcious with her nose in the spout of a 5 gallon gas can and almost died. Apparently she loved the smell of something that I find repulsive. As an adult she got into quite heavy drinking and died from cancer at age 38. Just because there is a family history of addiction does not mean that I would become addicted…..my own family history proves that. Some of these new regulations are OK but we still have a long way to go with all of this.,

  3. Wayne S. Swanson II on August 21, 2016 at 2:46 am

    I have taken this opportunity to share my heartbreaking story in hopes these witch hunting Opiate ill informed skeptics will read and understand that I would have no life without Medically prescribed Opiates by a physicians care and strictly monitored monthly urine and blood test. Please remember that An Opinion Before A Thorough Investigation Is The Epitome Of Ignorance! And that a little more compassion from the Medical Field and its representatives could have saved my beautiful Stepdaughters life. Let me say this! A person who has a addictive personality will abuse anything that helps them feel better. I have taken Oxycontin for 12 years , I have had 20 major surgery’s in 9 years. I have so much physical pain I can not even get out of bed with ouit pain meds and when I run out I run out and just lay in bed praying the Lord relieve me of this horrible condition and I pray God you pain med skeptics never go through what I go through everyday of my life when the only thing you have to do is threaten what help I get, Shame on you! There will always be drug abuse and as the so called war on drugs has failed all this will! All you do is stoke and aid the drug pushers business to knew heights in the Black Market of Heroin while depriving folks as me to this horrible movement! My Stepdaughter committed suicide 4 years ago because of being treated like a drug addict by her family and doctors when all along she suffered from Lupus and Fibro which I believe was brought on by a deadly car crash at 18 , she told me between that which I was being put through and what they were putting her through she was not going to live her life in such a hell brought on by people like you that are on a witch hunt to out law Opiates and pain meds that give us some sort of a life . As a retired Police officer and worked indirectly close to the DEA, you people do not have a clue how thrilled you are making the illegal opiate trade and think of my Late Stepdaughter as you continue on with this 2016 Version of the ( 1940s Propaganda Film named REEFER MADNESS )movement to outlaw opiates! Just like the slaughter of children at Sandy Hook if there would have just been gun laws , my God they were Gun Laws , the guns that murdered all those 20 children were all registered and owned by a school teacher! You fight Drug Addiction in Elementary education by teaching all children the dangers of Booze and Tobacco which if these witch hunters want for us to know the real truth but they do not. I miss my Stepdaughter a so much and some of us will continue on the fight to protect our right to feel better and function without fear of these witch hunters trying to convince us to commit suicide . And they are trying to do exactly THAT!
    The under line real truth is THESE witch hunters would rather us Chronic Pain sufferers commit suicide are and DRINK all the BOOZE we can drink! The Federals legalized it ( ALCOHOL) knowing its a more deadly drug than Strychnine. And just because the DEA has miserably failed with their witch hunt type movement on drugs why do they deprive us sick people of our Constitutional Rights to be Happy in that pursuit of with Professional Physicians to take meds that give us relief of this horrible malady of Chronic Pain ! May God have mercy on their miserable souls they that seek to destroy us Chronic Pain Sufferers only and little hope of temporary relief of this horrible sickness.

    • oxyman on August 21, 2016 at 7:57 pm

      Bravo. Stupid doctors. I went hey jtvtpday. Tried to reduce my daily dose by 40mg. Sure im gonna double doc it.

  4. meowmeow808 on August 22, 2016 at 11:25 pm

    I’m right there with you. For the last couple of days, this most recent ‘go-around’, I am ready to check out. I am so tired of living in pain. I’m only 55 and having been living with chronic pain for decades. It seems only when I started pain management and they implanted devices in me (intrathecal) that I am now wanting out of this life. The pain pump DOESN’T WORK. Recently changed pain meds but not hopeful. it’s just one thing after another and another and another….. I’m sure most of you know.
    I really, really, really, don’t want to go on anymore. I’ve twice asked my doctor to just give me a lethal does of something, which isn’t legal where I am, and he just tells me not to give up. Yeah, well let him try living in this pain every single damn day! I am not old but feel 110. My mother–in-law is 85 and in much better shape than me.
    I just want out. This type of life is not me and I miss me, as I’m sure others do too. But apparently ‘I’ am gone.

    • Chloe on October 31, 2017 at 5:58 am

      Hey, meow meow, pls tell me you’re still with us? And get back to me soon? I just told a social worker today the exact same thing you wrote last year: I miss me; this isn’t living; all my life force has been exhausted in battling pharmacologically treatable, but untreated, physical pain. Seriously? This soul lost its life in the prison and torture of mind bending pain, sleep deprivation and resultant social isolation. I loved my life, but this isn’t life . Have never done an illegal drug in my 62 years of life; no addiction issues history; no smoking, no drinking; no criminal history. Nastar gold skier, life long hiking and bicycling devotee. Managed arthritic and nerve pain with schedule 2 drugs for over 20 years, without any addiction or abuse issues; until they became “unavailable” to me. Sending prayers to you. If you moved on, Please look for me on the side of whatever veil I must soon pass thru as well.

  5. Gladys Rico-Flores on August 27, 2016 at 2:28 am

    It is not the Doctor’s who decide how much medication you get! There are many factors taking place…the DEA, The center for Medicare & Medicaid. Many doctors afraid to care for chronic pain patients because they worry about their Medical License taken away by the Medical Board. Guidelines for how much and what kind of medication you are prescribed. Federal and State entities making decisions about pain control without having adequate knowledge or scientific data to do so. Only your own Physician truly knows your conditions. Yet the media frenzy demonize Responsible, respected Physicians who only want the best interest of the patients. Just to be politically correct many chronic pain patients must suffer. We should never confuse the percentage of Opioid deaths with those who are heroin addicts. They are two different things. Soon we will not have enough Pain Dr.s or competent doctor’s to treat our growing number of people who require safe medical care.

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