Drug Monitoring Databases Allow Serve You Rx Pharmacists to See the Bigger Picture When Dispensing
The Prescription Drug Monitoring Program (PDMP) is a Wisconsin database that allows prescribers and pharmacists to query all of the controlled substances and other potentially harmful medications that have been prescribed or dispensed within certain jurisdictions. The PDMP has been in place since 2013, and an enhanced version launched in 2017 as a result of legislation passed to combat Wisconsin’s growing opioid epidemic. In 2017, there were 926 opioid-related overdose deaths in Wisconsin alone, as reported by the National Institute on Drug Abuse. The PDMP database is commonly used to decrease instances of doctor shopping and pharmacy hopping, but can also help detect risky or unnecessary controlled substance therapy, as well as identify prescribers with questionable or careless prescribing habits.
Wisconsin, home to Serve You Rx’s headquarters, is one of 49 states that currently participate in the National Association of Boards of Pharmacy (NABP) Prescription Monitoring Program (PMP) Interconnect program, which allows database information to be shared across different states. Some states require that their database be queried by pharmacists before dispensing drugs to their residents, but Serve You Rx pharmacies have elected to query whenever possible, whether or not it is mandated by law. Where data is not visible through Wisconsin’s own PDMP, Serve You Rx pharmacists will query other states’ databases and use their multiple state licenses to help them gain access to more information.
“The Wisconsin PDMP is really useful because of all the data it provides for our members who reside in Wisconsin,” said Jake Kachelmeier, Serve You Rx’s Manager of Pharmacy Operations. “The database can give alerts if members are overutilizing opioids, such as taking too high of a daily dose.”
Before these types of databases were made available, many pharmacists would simply call around to other local pharmacies when a patient’s drug-filling activity was suspicious in order to find out if the patient had filled at other locations recently. However, many patients tend to fill in different counties or states to avoid being detected—but the PDMP and Interconnect program’s capabilities tackle that issue.
When Serve You Rx pharmacists detect something that they find alarming or that appears to be a violation, they will contact the prescriber(s) involved and alert them of any concerns, such as duplicate therapy or dangerous drug combinations. Typically, this interaction results in the prescriber changing the therapy for the health and safety of the member. If Serve You Rx pharmacists are deeply concerned about a prescriber’s practices, they may contact law enforcement for further intervention. In instances where a prescriber chooses not to change the therapy despite Serve You Rx’s warnings, pharmacists always have the right to refuse to dispense the medication.
“It really is something that every pharmacist, regardless of their work setting, should be utilizing before dispensing controlled substances,” Kachelmeier stated. “Serve You Rx pharmacists have made it a part of their workflow to ensure these are checked.” He continued, “Stopping the opioid epidemic, and drug diversion in general, is a group effort. Medical professionals involved in the writing for and dispensing of these products have a shared responsibility to ensure we have done all we can to limit any wrongdoing. The PDMP is a wonderful resource to help them achieve this.”
The web-based nature of the databases is also beneficial to pharmacists because the use of exclusively electronic prescriptions decreases the risk of members duplicating physical paper prescriptions and trying to have them filled at multiple locations. Having electronic prescriptions come through the appropriate channel, and removing patients from the handling of prescriptions, helps to authenticate prescribers and pharmacies.
When it is revealed that a patient is receiving controlled substances, especially opioids, from more than one prescriber, Serve You Rx pharmacists contact all prescribers involved to make them aware.
“I received a prescription from a patient for a controlled stimulant medication,” began Kachelmeier. “When I checked the PDMP database, I noticed that the patient had received another stimulant from a different prescriber and had been going back and forth between the two. I called both of the prescribers and neither was aware that the patient had been getting this controlled medication from someone else.”
At one point, the prescriber had been suspicious of the patient and made him take a drug test before he prescribed the medication. Looking at the database, it was evident to Serve You Rx pharmacists that the patient had the second prescriber switch him to a different stimulant that can’t be detected on the drug test the patient was provided.
“It goes to show that the individuals who are doctor shopping can be quite smart about it,” said Kachelmeier. “They will go a long way to trick the system. The first doctor was very thankful that I caught this and was going to discuss alternative medications that are not controlled substances. He stopped prescribing the stimulant to the patient due to his actions.”
There are many other examples of how querying the PDMP database has assisted Serve You Rx pharmacists with detecting unnecessary or dangerous drug therapy.
Medications that are prescribed to animals by veterinarians are also visible in the PDMP database. On one occasion, Serve You Rx received a benzodiazepine prescription for a member and a pharmacist discovered that the member’s cat was also on a benzodiazepine. Further research revealed that the amount of benzodiazepines being dispensed for the cat would have been fatal to the animal if they were being taken as prescribed. This discovery led to many questions about where the medication was actually going. It was concluded that the member was likely misusing the controlled substance and Serve You Rx was able to intervene.
Another aspect of prescribing that the PDMP database helps detect is when members may be trying to potentiate the opioids they are taking with other, non-controlled drugs. Some states require reporting on certain drugs with abuse potential or high risk behavior, such as gabapentin, butalbital, naloxone, and cyclobenzaprine—even if they are not controlled in that state. The Drug Enforcement Administration (DEA) has advised against prescribing certain drug combinations that are considered very dangerous, such as an opioid, a benzodiazepine, and a stimulant or muscle relaxant. Serve You Rx has a case study about how querying the PDMP database detected a potentially lethal “drug cocktail” and was able to convince the prescriber to alter the patient’s therapy.
“These databases are very quick references for us that provide our pharmacists with a greater level of comfort when dispensing controlled substances,” Kachelmeier said. “We all hope for a single database someday that has all 50 states to make referencing easier for every pharmacist. Until that time, we will continue to use the resources available to us to ensure we are dispensing controlled medications as accurately and safely as possible.”