Association for Public Policy Analysis & Management

Strengthening Mandates for Prescriber Consultation of Prescription Drug Monitoring Programs in Delaware

The objective of this paper is to suggest wider and more objective criteria for mandated prescriber consultation of the prescription drug monitoring program in Delaware in order to address the opioid epidemic. In particular, it suggests the following legislative changes: mandatory consultation of PDMPs by prescribers every three months after initial prescription with certain exemptions for emergency and hospice care; punitive measures for prescribers and dispensers that fail to comply with mandated consultation; and training for physicians and pharmacists to facilitate compliance with mandates.

Too many people die from prescription opioid overdoses each year in the United States. According to the CDC, overdose deaths involving prescription opioids quadruped between 1999 and 2014, which closely mirrors the increase in opioid prescription sales. This increase in prescription sales has occurred despite evidence that opioids pose a significant public health risk, and despite a lack of evidence that they are effective in treating chronic non-cancer pain. Federal legislation has been passed to address this public health epidemic, but states vary in terms of their policies. Almost all states have established prescription drug monitoring programs (PDMPs), but mandates that prescribers actually query the system differ greatly from state to state. The criteria for obligatory prescriber consultation is particularly weak in Delaware, where the prescription opioid overdose death rate continues to rise. In Delaware, prescriber consultation of PDMP data is only required the first time a patient is being prescribed controlled substances in Schedules II to V, and when a prescriber has reasonable belief that a patient may be seeking a controlled substance for any reason other than the treatment of an existing medical condition. Without mandates, prescriber utilization of PDMP data is low. Evidence suggests that strong state-level mandates are successful in increasing the number of prescribers that check the database, decreasing the number of opioid prescriptions, and decreasing prescription opioid overdose death rates. This paper outlines available evidence regarding the effectiveness of state-level mandated consultation of PDMPs, as well as the experience in New York, an early implementer which is often cited as a model state in regards to PDMP legislation. This paper also includes a discussion of the current political moment and suggests a legislative path in Delaware that may be useful in passing stronger PDMP mandates.