The Heller School Prescription Drug Monitoring Program Center of Excellence, part of the Schneider Institutes for Health Policy, has launched research and data analysis designed to help drug prescribers prevent patient misuse of prescription drugs.
The Massachusetts Prescription Drug Monitoring Program and the Center have received several grants since 2008, including a grant from the U.S. Bureau of Justice Assistance, which has allowed the Center to conduct epidemiological studies of the drug monitoring data. Grants from the Food and Drug Administration (FDA) and the Center for Disease Control also permitted assessment of prescriber education and the development of early warning programs based on a multi-state database.
Peter Kreiner, research scientist and Principal Investigator for the Center, has headed a small team of research scientists since he started working at Brandeis in 2004. Kreiner specializes in substance abuse and prevention treatment and is working with the Massachusetts Prescription Drug Monitoring Program to further develop a state database that requires pharmacies to report all filled substance prescriptions, in order to to better keep track of a patient’s substance use and identify when a patient is abusing substances as well.
“The main purpose of these databases, is to help reduce and prevent prescription drug abuse and diversion, which is when people sell prescription drugs to other people. And also to facilitate appropriate prescribing,” Kreiner said.
According to Kreiner, every state except Missouri has passed legislation authorizing this program. Through this prescription monitoring database, prescribers (such as doctors and pharmacists) can register with the prescription monitoring program, query about a particular patient and get their prescription history. This database is especially useful for doctors, because while it is hard to observe pain and know if a patient is telling the truth, through this program it is easy to know if the patient has been to multiple doctors in the recent past, seeking the same medication. If so, the prescription drug monitoring program can indicate that the patient is not in legitimate pain.
Kreiner continued to describe two sorts of approaches to the program database. The first, a proactive approach involving prescribers and research scientists, entails analyzing the data for patterns that might indicate patients at risk for substance abuse.
“A proactive approach is when the program itself or a local university analyzes the data for patterns that show risky situations. Being proactive also makes this information available to prescribers, and in extreme cases it makes that information available to law enforcement as well,” Kreiner explained.
About half of the existing programs are prohibited from being proactive by individual state privacy laws, and half of the existing programs are legally able to analyze the data they collect, because of the amount of monetary resources data analysis requires. Currently, 16 states have proactive programs.
The second approach, of reactive nature, is much more widespread. “Nearly every program allows online access to the data. These databases are reactive in the sense that they are passive databases that require someone to access it,” Kreiner said.
The proactive prescription drug monitoring programs are especially useful. Once the data is available for analysis, medical examiners can use the data from one particular patient to help determine possible causes of death; Medicaid fraud units can more easily identify Medicaid patients paying for prescriptions in cash, when they should be paying with Medicaid; and community profiles can develop, helping law enforcement officials identify which cities and neighborhoods have particularly high rates of prescription drug abuse by mapping patterns of pain reliever and stimulant trafficking.
“When mapping is done, you can see that patterns of pain relievers are very different than patterns of stimulants in Massachusetts. You can see patterns of combinations of drugs that have desirable effects when prescribed together as well as rates of use of fatal and nonfatal opioids within different age ranges,” Kreiner added. “One big value of prescription monitoring data, is that it’s very timely. The systems are updated every week. Oklahoma prescribers update their system within five minutes of prescribing medications.
While prescription drug monitoring presents many benefits, it also poses several drawbacks that highlight the importance of ensuring limited access to this information.
“Authorized users have to sign forms saying they will only use the data for appropriate means,” Kreiner said.
Information about drug use and abuse, if accessed, can expose celebrities to unwanted news coverage and can expose unflattering information in bad divorce cases. “Programs are trying to build safeguards against this happening,” Kreiner said. “States can vary greatly on who is allowed to see this information, and on how users are authorized.”
Kreiner continued to say that deaths from prescription drug overdoses is the leading cause of death nationwide, killing more people than auto accidents, as well as more than heroin and cocaine associated deaths combined. “Many of physicians and prescribers are recognizing that prescriber education is a big problem, since there are currently no widely accepted guidelines about how to prescribe opioids or pain relievers,” Kreiner said.
According to Kreiner, this program represents a vastly underused resource. It also represents a new sector for people who study drug abuse. Historically drug abuse has been centered in urban areas, yet with a newly heightened awareness of prescription drug abuse through mapping, researchers like Kreiner are finding that the worst offenders are young, white, suburban and middle class.
Kreiner, who came to Brandeis from a private non-profit research company in 2004, is very pleased with working in a university setting. “The university setting for this work gives a legitimacy to the work that is different than a private research company. That has been very important to some of the grants we’ve gotten, and it has allowed us a lot of latitude and gotten us a lot of support.”
