About the Prescription Drug Monitoring Program
What the Program Does and Does Not Accomplish
The Problem – Illegal Diversion and Abuse of Prescription Drugs
- Florida has a serious problem with illegalprescription drug diversion and abuse. Scheduled drugs that are prescribed by physicians are diverted from their intended use and then abused or illegally sold. Drugs diverted include Schedule II, III, and IV controlled substances. Many of the diverted drugs are powerful pain killing opiates that have a high potential for addiction and abuse.
- Prescription drugs now kill six Floridians per day – five times as many as caused by all illegal drugs combined.
- The rate of deaths caused by prescription drugs is also increasing nearly five times as fast as the rate of deaths caused by all illegal drugs
- In 2008, when alcohol is excluded, prescription drugs account for 75% of all drug occurrences in the Medical Examiners Report.
- The rate of deaths (per 100,000 residents) caused by prescription drugs is over three times as high as the rate of deaths caused by all illegal drugs combined
- In Florida, drug-related deaths continue to increase:
| 2003 | 2004 | 2005 | 2006 | 2007 | 2008 |
| 6,767 | 7,128 | 7,573 | 7,741 | 8,620 | 8,556 |
- A major problem is the establishment of “pill mills”
- A “pill mill” is a doctor’s office, clinic, or health care facility that routinely conspires in the prescribing and dispensing of controlled substances outside the scope of the prevailing standards of medical practice in the community or violates the laws of the state of Florida regarding the prescribing or dispensing of controlled prescription drugs
- According to the Drug Enforcement Administration’s Automation of Reports and Consolidated Orders System (ARCOS) reports, Florida physicians dispense five times more oxycodone than the national average of dispensing physicians.
- Prescription drug diversion costs lives, increases crime and misery from drug addiction, and accelerates costs connected to treatment, medical expenses and Medicaid fraud.
Bottom line: The state of Florida has an epidemic causing death and the loss of human dignity due to the abuse and diversion of controlled Prescription Drugs; it is a public health and safety problem for Florida.
The Goals of the Prescription Drug Monitoring Program (PDMP)
- Support access to legitimate medical use of controlled substances
- Help identify and deter or prevent drug abuse and diversion
- Facilitate and encourage the identification, intervention with and treatment of persons addicted to prescription drugs by health care practitioners
- Help inform public health and safety initiatives through the outlining of use and abuse trends of controlled prescription drugs
- Help educate individuals about PDMPs and the use, abuse and diversion of and addiction to controlled prescription drugs
The Attributes of the PDMP: How the Program Operates
- FS 893.055 creates the Prescription Drug Monitoring Program (PDMP): and the accompanying Public Records law FS 893.0551 limiting access to confidential and private information in the PDMP database.
- Establishes the Patient Advisory Report (PAR) for use by practitioners to alert them of patients that are possibly “doctor shopping.”
- Requires dispensing practitioners to report dispensed II – IV controlled drugs to the database electronically no later than 15 days from the date of dispensing.
- Allows practitioners to request access to the patient’s prescription history information during office visit to ensure better patient standard of care, avoid prescribing medications that may be dangerous when taken in combination and identify possible “doctor shoppers”
- Limits access to database information to only practitioners and six entities including patients. The six entities do not have direct access to the database; they must request it from the PDMP Program Manager: Attorney General, health care regulatory boards, law enforcement (defined as Florida Department of Law Enforcement, Florida Sheriffs’ Offices and Florida Police Departments), the Department of Health, the Implementation and Oversight Task Force and patients to verify their prescription history.
- Requires the Department of Health to use the information to undertake public health care and safety initiatives that take advantage of observed trends
- Requires training for user knowledge of how to access/request information and provide knowledge of the program as determined by the Department of Health
- Requires an annual report by the Implementation and Oversight Task Force to the Governor, the President of the Senate, and the Speaker of the House of Representatives regarding implementation, compliance, and measures taken to ensure privacy and confidentiality of records.
- Establishes a Direct Support Organization (DSO) in order to fund the PDMP with non-state funds; Department of Health in order to implement the PDMP does not use state legislative appropriations
- Requires the use of requesting patient identification by dispensers if the patient or person picking-up the controlled prescription drug is unknown to the dispenser
What the PDMP Does Not Accomplish
- Does not allow interstate sharing of prescription history information
- Is not National All Schedules Prescription Electronic Reporting Act (NASPER) qualified; federal grant for establishment of PDMPs with interstate sharing
- Florida, if not NASPER qualified, may not have a preference for drug abuse competitive grants awarded by the Secretary, Substance Abuse and Mental Health Services Administration (SAMHSA) starting in FY 2012
- Does not have the ability to provide “alerts” to regulatory boards, Medicaid fraud or law enforcement regarding potential “doctor shopping” or illegal and/or unprofessional conduct by health care professionals
- The PDMP is not the one “silver bullet” that by itself will reduce all diversion and abuse of prescription drugs in Florida.
What the PDMP Does Accomplish
- In short, the establishment of this system in Florida will prevent a great number of deaths from the illegal diversion and subsequent abuse and overdose of prescription drugs in our state.
- The use of the PDMP by physicians contributes significantly to patient safety and improved patient standard of care
- The PDMP allows practitioners to see all of the Rx data of their patients
- Rx history is available when patient is present
- Assists with making complex prescribing decisions for the elderly
- Provides practitioner state-wide visibility of “doctor shopping
- The PDMP reduces the chances for patients to repeatedly and illegally divert prescription drugs.
- The program allows for health care regulatory boards and law enforcement officials to rapidly investigate cases where abuse of controlled substances is suspected; requires an active investigation to request information. See attached diagram.
- The PDMP protects both privacy and confidentiality of patients by following all state and federal laws to include HIPAA plus additional control measures beyond those requirements. See Chart 3 for Project Manger required validation of request
- It facilitates and encourages the identification, intervention with and treatment of persons addicted to prescription drugs
Conclusion: The state of Florida has established a program that will improve patient quality of care and reduce controlled prescription drug abuse and diversion. The PDMP will reduce the chances for patients to repeatedly and illegally divert prescription drugs. Overall the program will dramatically reduce doctor and pharmacy shopping.