Email updates

Keep up to date with the latest news and content from BMC Pharmacology and Toxicology and BioMed Central.

Open Access Highly Accessed Commentary

An inevitable wave of prescription drug monitoring programs in the context of prescription opioids: pros, cons and tensions

M Mofizul Islam* and Ian S McRae

Author Affiliations

Australian Primary Health Care Research Institute, Australian National University, Building 63, corner of Mills & Eggleston Roads, Canberra, ACTON ACT 0200, Australia

For all author emails, please log on.

BMC Pharmacology and Toxicology 2014, 15:46  doi:10.1186/2050-6511-15-46

Published: 16 August 2014

Abstract

Background

In an effort to control non-medical use and/or medical abuse of prescription drugs, particularly prescription opioids, electronic prescription drug monitoring programs (PDMP) have been introduced in North-American countries, Australia and some parts of Europe. Paradoxically, there are simultaneous pressures to increase opioid prescribing for the benefit of individual patients and to reduce it for the sake of public health, and this pressure warrants a delicate balance of appropriate therapeutic uses of these drugs with the risk of developing dependence. This article discusses pros and cons of PDMP in reducing diversion of prescription opioids, without hampering access to those medications for those with genuine needs, and highlights tensions around PDMP implementation.

Discussion

PDMPs may help alleviate diversion, over-prescription and fraudulent prescribing/dispensing; prompt drug treatment referrals; avoid awkward drug urine test; and inform spatial changes in prescribing practices and help designing tailored interventions. Fear of legal retribution, privacy and data security, potential confusion about addiction and pseudo-addiction, and potential undue pressure of detecting misuse/diversion - are the major problems. There are tensions about unintended consequence of excessive regulatory enforcements, corresponding collateral damages particularly about inadequate prescribing for patients with genuine needs, and mandatory consultation requirements of PDMP.

Summary

In this era of information technology PDMP is likely to flourish and remain with us for a long time. A clear standard of practice against which physicians’ care will be judged may expedite the utilisation of PDMP. In addition, adequate training on addiction and pain management along with public awareness, point-of-supply data entry from pharmacy, point-of-care real-time access to data, increasing access to addiction treatment and appropriate regulatory enforcement preferably through healthcare administration, together, may help remove barriers to PDMP use.

Keywords:
Prescription drug monitoring programme; Prescription drugs; Controlled drugs; Prescription opioids