PDMP October Meeting

PDMP Meeting Summary of 10/18/2024 submitted for OPSO

The Prescription Drug Management Commission convened on October 18^th for its quarterly session.  I represent OPSO and at this time continue to be the only DO or MD on the Commission.  Below are highlights of reports presented in the meeting and links to documents that represent the continuous transparency of the Commission to communicate with our constituents and evaluate effectiveness of the program.

User Compliance Activities:

An overall 3% increase since the last Advisory Commission update. This is in part due to significant

collaborative efforts between the PDMP and Oregon Medical Board sending targeted messaging to

unregistered OMB licensees.

2nd Quarter 2024 Report (April 1 - June 30) Summary

• The percentage of prescribers enrolled in the PDMP system has stayed consistent compared to

  the 2nd quarter of 2023

• Gateway automated queries (EMR linked) have increased (24.6%) while web queries have decreased (-29.8%) from the 2nd quarter of 2023. Integrated reports viewed have seen a large increase of 40.6% indicating a steady and increasing usage of the PDMP.
• Overall, the total number of prescriptions for controlled substances have increased (3.5%) since the 2nd quarter of 2023. Gabapentin is the most prescribed substance in the system with a slight decrease (-1.2%) in prescriptions over Q2 2023. Stimulant prescriptions continue to rise with amphetamine prescriptions increasing 10.5% and methylphenidate prescriptions increasing 7.8%.

The PDMP Prescribing Practice Review Subcommittee continues to notify practitioners of specific potential risky prescribing behaviors. Letters are educational and not punitive in nature. This responsibility is pursuant to 2017 HB 3440:

“The subcommittee shall develop, through the use of PDMP information criteria by which a practitioner may be required to receive education or training on prescribing of opioids. Sthe subcommittee may review PDMP information on a practitioner’s prescribing history (that does not identify a patient), to determine whether a practitioner meets the criteria for receiving education/training. The subcommittee may direct OHA to provide to a practitioner who meets the above criteria educational information about prescribing opioids for pain.”

Key practices reviewed

• Co-prescribing an opioid and sedative (benzodiazepine, non-benzo sedative, or gabapentin) to the same patient with overlapping use dates by the same prescriber. This was refined in 2023 to remove single-procedure co-prescribing. The threshold remains 15 or more patients in a quarter.
• Opioid Naïve Patient:
  • Prescribing long duration opioids (31 or more pills or 7-day liquid supply)
  • 15 or more patients a quarter
• Multiple prescribers
  • Patients with at least 4 different opioid prescribers in a quarter
  • 50 or more patients in a quarter

  High MME prescribing

• • High minimum morphine equivalent (MME) of 200+ to a patient (Hospice patients are excluded)
  • 20 or more patients in a quarter
• Tri-prescribing
  • Co-prescribing an opioid, a sedative (benzodiazepine, non-benzo sedative, or gabapentin), and a stimulant to the same patient with overlapping use dates by the same prescriber
  • 5 or more patients in a quarter

Legislative Follow-up

• Veterinarian opioid prescribing data will begin being monitored in 2025
  • Although cases will be tagged by the owner’s name, entries will clearly identify that this is for a pet/livestock
  • Veterinarian data will not be included with the data review for patient Rx trends for physicians and other non-veterinarian prescribers
• Sharing of data with the Military PDMP system will require legislative change (information sharing currently limited for state-to-state sharing). Veteran Health Administration sharing can occur within Oregon, but not nationally.
• A new PDMP System RFP will be pursued in 2025 (Current vendor is Bamboo Health who likely will pursue, but others are interested).

Links to Two recent publications are included for your review:

A study by the Oregon Health Authority in collaboration with Comagine Health:

Impact of PDMP-HER Integration on Risky Opioid Prescribing. This report identified that the level of improvement varied by healthcare entities for some outcomes.

Greater improvement:

• Hospitals experienced greater improvement on two outcome measures—reduced high dose opioid prescribing and Opioid/Benzodiazepine co-prescriptions compared to other healthcare entities;

• Rural entities experienced greater improvement on reduction of Opioid/Benzodiazepine co-prescriptions —compared to other healthcare entities

  Mixed findings:

• Group practice entities experienced greater improvement in reducing their prescriptions to patients with multiple prescribers, but less improvement in reducing their opioid/benzodiazepine co-prescribing compared to other healthcare entities;

  Less improvement:

• Emergency departments experienced less improvement on one outcome measure—patients with multiple prescribers, compared to other healthcare entities;
• Independent practice entities experienced less improvement on one measure—high dose opioids compared to other healthcare entities; and
• Large Volume Organization entities experienced less improvement on one measure—patients with multiple prescribers, compared to other healthcare entities.

   

   

   

   

  Researchers at the Oregon Health and Science University produced a study of the impact of PDMP integration: Effect of Integration of Prescription Drug Monitoring Program Data in the Electronic Health Record on Queries by Primary Care Providers Integration, revealed:

• Integration of the PDMP in the EHR was associated with a significant increase in use in primary care clinicians in one academic medical center. The largest increases in queries were among those with the most infrequent PDMP use before integration.

• Throughout the study, NPs and PAs queried the PDMP more than physician providers.
• Despite the promise PDMP integration holds for increased use and improved outcomes, less than a quarter of office-based physicians and 10%-15% of hospitals report PDMP integration within their EHR.

Respectfully Submitted,

John T. Hinton, DO, MPH