Working Together to Prevent Prescription Drug Abuse
June 26th, 2017

Over 80 Organizations Sign Letter to Congress Asking for Robust, Adequately Funded PDMPs

February 23, 2016

Dear Leader McConnell, Minority Leader Reid, Speaker Ryan and Minority Leader Pelosi:

We write to you as leading participants in the prescription drug supply chain – i.e., manufacturers, distributors, payers, physicians, pharmacies, testing laboratories, treatment providers – as well as patient groups, business leaders, and other expert parties, to urge the full support of Congress (and state legislatures) of the continued expansion and deployment of robust and interoperable Prescription Drug Monitoring Programs (PDMPs) in each of the 50 states.  We recognize that the focus of Congress is in the development of federal policy, but advise that the complexity and interplay between federal and state policy in addressing the prescription drug abuse epidemic is undisputed and recommend a committed partnership between all levels of government to realize this objective.

The current trajectory of non-medical abuse of prescription opioids, and the diversion of these important medicines from their intended purpose, is troubling and unacceptable.  The U.S. Centers for Disease Control & Prevention (CDC) reported that in 2013 nearly 23,000 Americans died from prescription drug overdose.   As of 2011, the National Institute on Drug Abuse (NIDA) estimated that more than 52 million Americans ages 12 and older had used prescription drugs non-medically in their lifetime. Fifty-four percent of non-medical users of prescription drugs surveyed claim they obtained the medicines from a friend or family member.

Prescription drug diversion and abuse is a public health crisis that must be confronted and addressed comprehensively, and with the collaboration of all stakeholders.  While many of the signatories on this letter have put forth comprehensive approaches to addressing prescription drug abuse and diversion – e.g., consumer and physician education, prevention and intervention, disposal, and treatment – and such elements certainly must be pursued vigorously, there is consensus among nearly all stakeholders regarding the need for each state to fully develop and operate a robust and efficiently-deployed PDMP.

PDMPs are statewide electronic databases designed to monitor the prescribing and dispensing of controlled substances — or scheduled drugs, as determined by federal regulation.  PDMPs have been shown to assist physicians in identifying patterns of prescribing and abuse so that prevention, intervention and treatment can occur.  There is sufficient validating evidence demonstrating that a reduction in incidences of doctor shopping correlates to a reduction in abuse.

But while 49 states currently operate PDMPs, a combination of factors, including widely varying data elements, a lack of interoperability and dedicated resources, and an inadequate level of resources committed by many states, has served to chill the regular use of PDMPs.  These factors only serve to embolden abusers who more readily circumvent the program by selecting providers who do not regularly consult PDMPs, or cross state borders that do not have interoperability with other state PDMPs .

A robust and effective PDMP should include a litany of elements, but we believe that these programs at a minimum must be adequately maintained and funded, available at the point-of-care with up-to-date information, and integrated into the prescriber and dispenser workflow.  When these characteristics are achieved, PDMPs will represent a major step toward ensuring that patients have access to the care they need, and that these medicines are not inappropriately prescribed, dispensed or diverted.  Other desired elements for an effective PDMP include, among others:

  • Interoperability between state databases
  • Easier access requirements for physicians, e.g., user name and password processes
  • Physician access to patient prescription history, both his/hers or other prescribing
  •         physicians
  • Physician authorization to delegate practice monitoring responsibilities to office personnel
  • Protection of patient confidentiality
  • Support of a public health over a law enforcement function

The first major Congressional step that could be taken immediately to bolster PDMP programs and combat the growing prescription drug health problem would be to reauthorize the National All Schedules Prescription Electronic Reporting Act (NASPER).  We applaud the U.S. House of Representatives for passing its NASPER reauthorization bill, H.R. 1725, and encourage the Senate to act on this important legislation swiftly. This program was created in 2005 to allow the U.S. Department of Health & Human Services (HHS) to award grants to states to establish or enhance PDMPs, and establish best practices.  NASPER has not been funded since a prohibition was included in the FY2011 continuing resolution (P.L. 112-10); however, we are confident that reauthorization and full funding of NASPER would be a significant step toward reversing the current trajectory of abuse.

We thank you for your consideration of this request, and hope that you will consider each of the stakeholders on this letter to be partners in the effort to combat this growing public health problem.

Sincerely,

Advocacy Council of the American College of Allergy, Asthma and Immunology

Alaska State Medical Association

America’s Health Insurance Plans

American Academy of Emergency Medicine

American Academy of Family Physicians

American Academy of Home Care Medicine

American Academy of Hospice and Palliative Medicine

American Academy of Orthopaedic Surgeons

American Academy of Otolaryngic Allergy

American Academy of Otolaryngology—Head and Neck Surgery

American Academy of Pain Management

American Academy of Pain Medicine

American Academy of Physical Medicine & Rehabilitation

American Association for Geriatric Psychiatry

American Association of Neurological Surgeons

American College of Emergency Physicians

American College of Phlebology

American College of Physicians

American College of Rheumatology

American College of Surgeons

American Medical Association

American Osteopathic Association

American Psychiatric Association

American Rhinological Society

American Society of Addiction Medicine

American Society of Dermatopathology

American Society of Echocardiography

American Society of Interventional Pain Physicians

American Society of Plastic Surgeons

Arkansas Medical Society

California Medical Association

Cardinal Health

Colorado Medical Society

Congress of Neurological Surgeons

CVS Health

Federation of State Medical Boards

Generic Pharmaceutical Association

Healthcare Distribution Management Association

Idaho Medical Association

Illinois State Medical Society

Indiana State Medical Association

International Society for the Advancement of Spine Surgery

Iowa Medical Society

kaleo

Kansas Medical Society

Kentucky Medical Association

Mallinckrodt Pharmaceuticals

Massachusetts Medical Society

MedChi, The Maryland State Medical Society

Medical Association of the State of Alabama

Medical Society of Delaware

Medical Society of New Jersey

Medical Society of the District of Columbia

Medical Society of the State of New York

Medical Society of Virginia

Michigan State Medical Society

Millennium Health

Mississippi State Medical Association

Missouri State Medical Association

National Association of Chain Drug Stores

National Association of Medical Examiners

Nebraska Medical Association

New Hampshire Medical Society

North American Neuromodulation Society

North Carolina Medical Society

North Dakota Medical Association

Ohio State Medical Association

Oregon Medical Association

Pain Care Coalition

Pennsylvania Medical Society

Pharmaceutical Care Management Association

Prime Therapeutics

Rhode Island Medical Society

Society of Hospital Medicine

South Dakota State Medical Association

Spine Intervention Society, The

Tennessee Medical Association

Teva Pharmaceuticals

Texas Medical Association

The American Pain Society

The Center for Medicine in the Public Interest

The Pain Community

Urgent Care Association of America

Utah Medical Association

Vermont Medical Society

Virginia Cancer Pain Initiative

Washington State Medical Association

Wisconsin Medical Society

 

cc:

Chairman Lamar Alexander

Senate Committee on Health, Education, Labor &Pensions

 

Ranking Member Patty Murray

Senate Committee on Health, Education, Labor &Pensions

 

Chairman Fred Upton

House Committee on Energy and Commerce

 

Ranking Member Frank Pallone

House Committee on Energy and Commerce

 

Chairman Thad Cochran

U.S. Senate Committee on Appropriations

 

Vice Chairwoman Barbara Mikulski

Senate Committee on Appropriations

 

Chairman Harold Rogers

House Committee on Appropriations

 

Ranking Member Nita Lowey

House Committee on Appropriations