Are you using a Prescription Drug Monitoring Program?

[Extralong]

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So I've started ramping up the use of my state's Prescription Drug Monitoring Program(PDMP). Its been very helpful. I get a ROI(release of info) and then I try to consolidate the patient's controlled substance usage by calling the other providers letting them know my concerns. I have been totally surprised by what patients report vs what I find. Additionally, to my surprise, other providers are pretty thankful that I let them know.

At times, after I finish with the patient, I let them know that my state has this system, and what I find in the PDMP.

What do you think of PDMPs? do you use them? are they helpful? Any good stories?

-E

 

[Indodo]

You get a ROI to use the PDMP or to talk to other physicians?

 

[Extralong]

Oh, good point, ROI to talk to other physicians. I do the PDMP before I even see the patient. I had this one lady(65y.o.) that was getting Xanax, Klonopin, Soma, Suboxone, Ambein, and an occasional temazepam PRN sleep, from 4 different providers that came to me stating that see has trouble sleeping, focusing, and wanted a stimulant.

I was contemplating if I should give her info for a good deal on a casket.

 

[Indodo]

This is something that I don't routinely do. Maybe I should but a part of me strongly believes that this is really where the pharmacist should play a much bigger part.

 

[sunlioness]

I do quite a bit. Such a useful tool.

 

[splik]

i use it for patients who are coming along wanting controlled substances and will look up the PDMP before seeing them. also any pts i am rxing controlled substances to. otherwise i don't. btw you don't need an ROI to contact the patient's other providers to let them know. some patients won't want you to contact them and wont give you permission. but you dont need it per HIPPA if they are a concurrent provider. i should probably check to PDMP for every patient but that seems too time consuming.

 

[strangeglove]

NY State requires checking before writing every prescription for a scheduled medication. It's very helpful, if slightly time-consuming. I make it clear to patients that I am doing this at the beginning of treatment, as part of the frame around prescribing of controlled substances, along with random urine drug screens, etc. I make sure they know it's nothing personal and that I check for everyone. I also let patients know hat that I have the right to call other providers about concerns about multiple prescribers without their consent, and I also inform patients of this fact upfront. If they don't like it, they always have the choice of leaving my care, which is preferable to me if they are patients who tend to divert scheduled medications.

 

[nitemagi]

FYI the old HIPAA privacy rules of requiring consents to talk to other providers are long gone. As long as it's considered "coordination of care."
Most people still presume you need a consent for every little thing.
http://www.hhs.gov/ocr/privacy/hipaa/faq/privacy_rule_general_topics/193.html
http://www.hhs.gov/ocr/privacy/hipaa/faq/privacy_rule_general_topics/192.html

 

[milesed]

State law in my state (KY ) requires checking all patients on scheduled drugs - it's an online database that must be checked at least every 90 days.

 

[whopper]

While in Ohio, I was ticked off Kasich became governor. That guy used to be a bombastic talking-head on Fox News that covered O'Rielly when he was on vacation.

But, and this only became apparent after he became governor, he's done a good job, and has been very friendly to mental health providers. Before he became gov, he publicly announced his brother has schizophrenia and he would do quite a lot to help mental health providers. He's done that. As governor he's not been bombastic. In fact several people I know in state hospitals told me he's been instrumental in helping them do things to make those places work better.

I don't know if KY followed Kasich's lead (I think they did). Kasich worked on legislation to make it harder to open a pill-mill, and to utilize PDMPs more. KY and Ohio are neighboring states and often follow Ohio's lead in terms of mental health advancements.

Getting to the original post, PDMPs are very helpful, especially in an ER setting or Suboxone clinic. In the ER, whenever we saw someone ask for a possible med of abuse, we looked their prescriptions in the state database and quite a few times we found them doctor shopping all over town for meds.

 

[Indodo]

Didn't you also have a psychologist for a governor? I was surprised that no psychology rx legislation got through in ohio.

 

[whopper]

Forgot the previous governor's name and yes he was a psychologist. Don't be surprised about the psychology rx legislation. Most psychologists I know oppose it as well.

 

[milesed]

While in Ohio, I was ticked off Kasich became governor. That guy used to be a bombastic talking-head on Fox News that covered O'Rielly when he was on vacation.

But, and this only became apparent after he became governor, he's done a good job, and has been very friendly to mental health providers. Before he became gov, he publicly announced his brother has schizophrenia and he would do quite a lot to help mental health providers. He's done that. As governor he's not been bombastic. In fact several people I know in state hospitals told me he's been instrumental in helping them do things to make those places work better.

I don't know if KY followed Kasich's lead (I think they did). Kasich worked on legislation to make it harder to open a pill-mill, and to utilize PDMPs more. KY and Ohio are neighboring states and often follow Ohio's lead in terms of mental health advancements.

Getting to the original post, PDMPs are very helpful, especially in an ER setting or Suboxone clinic. In the ER, whenever we saw someone ask for a possible med of abuse, we looked their prescriptions in the state database and quite a few times we found them doctor shopping all over town for meds.

Not sure. The rep who sponsored the most recent bill making it law requiring we check the database came from eastern KY where the opiates are out of control. Our database has been in place at least as far back as 2001. We also have to get baseline and random drug screens for all adults on scheduled drugs. I see kids and have caught no one with the database, but we catch tons of adults with it and the UDS.

 

[whopper]

Yeah I'm not sure. Often times when one state does something it directly influences the neighboring states. Ohio is very advanced when it comes to the law and mental health. I don't know the exact reason why but for at least the last 20 years there's several landmarks showing this such as the building a Summit Behavioral Healthcare, a long-term forensic facility with state of the art psych facilities, getting inmates appropriate psychiatric care in the metropolitan areas, having some of the best-of-the-best in several aspects such as the Cleveland Clinic, the Lindner Center of Hope, University of Cincinnati, Phil Resnick, Paul Keck, Susan Mcelroy, Henry Nasrallah (just left over a year ago), Doug Mossman, etc.

Greater Cincinnati Behavioral Health is a community mental health institution that has a national rep. Anyone the courts in Cincinnati want to be seen by a psychologist or psychiatrist gets done often times within 24 hours, people in the jails in the bigger cities get psychiatric care.

The psych ER at University of Cincinnati has been considered one of the best in the country and a model that many others emulated.

I've been spoiled.

In St. Louis, I'm fighting tooth and nail just for a guy to get his psych meds in the county jail only to be told no by people who are likely violating the law but I got no legal power teeth to fight back.

I'd say Ohio was more advanced vs KY in terms of the legal/state infrastructure of mental health. That is not a criticism against KY psychiatrists or psychologists. I'm talking only about the infrastructure, not individual providers. The only thing I can think of that wasn't state of the art in terms of the infrastructure going on is Ohio doesn't have an involuntary outpatient treatment program like NY does.
It definitely is more advanced than Missouri. I can't get the patients half the services I want them to get in this area.

 

[Extralong]

Thanks for your input everyone