What Are Prescription Drug Monitoring Programs and Why Do They Make Sense?

NJ Spotlight’s description of Prescription Drug Monitoring Programs (PMP’s) is the best I can find anywhere on the internet. You should click on that link before continuing with this post.

I have a friend who was clean and sober for 13 years. He had a problem with alcohol and heroin. He got clean in his early 20’s, earned a professional degree, got married, bought a townhouse and had a respectable job. He had a back injury and was prescribed prescription painkillers. He found that he really liked them and quickly began to take more than was prescribed. Pills that were supposed to last 30 days would last 10…so he began to see other doctors and have them prescribe him more painkillers (this is called doctor shopping). He would get Oxy 30’s from the the North Brunswick Rite-Aid, Vicodin from Flemington Eckerd and more Oxy 30’s from the New Brunswick Walgreens.

This was before NJ had a PMP, so none of the doctors that he saw could check to see if he had gotten other drugs from other doctors. They could only see what he got at their own facility. The same was true for pharmacists – they could not see what he was getting from other pharmacies. As a result, he got terrible medical care and was able to game the system (and abuse his mind and body). His life spun out of control, and his job, marriage and life were in danger.

New Jersey’s PMP was instituted in January of 2012 (my Task Force colleague Tom Calcagni was the driving force behind it). In March of 2012, my friend went to two different doctors and got two separate prescriptions for painkillers. He filled one at a pharmacy in Somerville. He tried to fill the other prescription at a pharmacy in Edison, but the pharmacist checked the PMP and saw that he had just gotten the other prescription filled. My friend left (it was a good job by a diligent pharmacist…except that pharmacist should have alerted the authorities so that my friend could have been dealt with).

The NJ PMP has been up and running for 2 1/2 years, but only 15 (15!) doctors and advanced nurse practitioners use it. Pharmacists are much better, but less than 20% of them check it. A PMP can be very effective at preventing prescription drug abuse,  catching abusers, and cutting the supply of drug dealers (some people doctor shop to stock up on pills to sell) if it has full participation by prescribers and dispensers. 16 states currently have mandated PMP’s; sadly, NJ is not one of them.

My friend continued to abuse prescription drugs throughout the summer and fall of 2012. He bounced in and out of treatment centers. At one in-patient rehab, he learned from other patients which pharmacies and doctors use the PMP and which ones don’t. This kind of news is valuable in the drug using community and travels fast. After he left that treatment center and relapsed, he sought out the doctors and pharmacies that didn’t use the PMP.

Last summer, the NJ State Commission of Investigation released a report that urged the governor and the legislature to make the PMP mandatory. This March, the State Task Force on Heroin and Other Opiates made the same recommendation. Despite the fact that more people in NJ die every year from opiate overdoses, mandated PMP bills continue to meet resistance from some doctors and legislators. A few of the doctors that have spoken out against it (including Burlington Democratic Assemblyman Herb Conway) say that it will unduly burden their profession. More accomplished doctors like Dr. Louis Baxter think it is necessary and non burdensome. There may be no one that knows more about drug policy in America than Dr. Thomas McLellan; not surprisingly, he also supports mandating PMP’s.

The infra-structure of the PMP is already in place in NJ. Mandating it will cost very little and the benefits will be large (it will save money and lives). It will add a few minutes a day to the workload of a doctor (actually, it won’t – the bill we support allows for an office staff member to enter and check the PMP).

My friend’s wife went to Al-Anon, set firm boundaries and forced him to get honest and go to treatment. He’s clean and sober for over a year now and doing much better. He is very lucky. He could have overdosed, gotten arrested, been fired from his job or lost his marriage. If NJ had a mandated PMP, he would have been caught much earlier. If he had died, his friends and family would have been left to wonder what might have been. It didn’t happen to him, but it happens so many other times.

This is a no-brainer. Governor Christie knows it, but he won’t push for it. If we can’t pass it in NJ, I’m cynical about our ability to make changes in more difficult areas to address this epidemic.