Provider Usage and Integration of Controlled Substance Databases in Florida
Executive Summary
On October 1, 2017, Florida enacted 29 F.S. § 401-253 to create a main database that can be accessed quickly by providers to report controlled substance related overdoses. Additionally, 46 F.S. § 893-055 (2017) outlines a prescription drug monitoring program (PDMP) that providers can query for controlled substance prescription data on their patients. This combination of data can help providers analyze unsafe trends in substance use prior to writing prescriptions (McAllister et al., 2015), which may help reduce the amount of opioid-related deaths— over 30,000 in 2015 (Centers for Disease Control and Prevention [CDC], 2016).
PDMPs have a positive impact in decreasing the number of opioid related deaths in Florida (Delcher, Wagenaar, Goldberger, Cook, & Maldonado-Molina, 2015);however, low provider usage scores persist due to certain barriers (Young, Tyndall, & Cottler, 2017).
Furthermore, the reporting systems are not integrated, which can limit vital information for providers writing prescriptions (29 F.S. § 401-253, 2017; 46 F.S. § 893-055, 2017).
Background and Scope of Problem
The cost of prescription opioid exploitation in the U.S. was almost $80 billion in 2013(Florence, Zhou, Luo, & Xu, 2016). The CDC (2017) identified a four-fold increase in opioid overdose related deaths since 1999, and more than 1000 daily ER admissions are due to opioid abuse. Florida had a 22.7 percent increase in drug-related deaths from 2014-2015 with opioids as the leading cause (CDC, 2016).
PDMPs have a positive impact in decreasing the number of opioid related deaths in Florida. However, studies show that provider usage of the PDMP in Florida is low due to inadequate access, a lengthy sign-up and information retrieval process, a lack of education,
reduced data reliability, and software environment issues (Young et al., 2017). Florida received over $27 million of grant money to help fight the opioid epidemic (United States Department of Health and Human Services [HHS], 2017). These monies are vital to providing research on seamless integration of controlled substance databases, to delivering provider education on Florida’s PDMP, and to eliminating barriers to utilizing such software.
Position Statement and Policy Recommendations
Advanced Practice Nurses for Opiate Safety (APNOS) endorse increasing the use of PDMPs and integrating controlled substance overdose data within a centralized data system that is easily accessible to providers (46 F.S. § 893-055, 2017). This would be consistent with the HHS (2017) 5-Point Strategy to Combat the Opioid Crisis— potentially decreasing opiate overdoses and misuses and helping substance abusers get professional assistance. Additionally, Florida healthcare providers will have more confidence when writing pain medication prescriptions by having this data available (McAllister et al., 2015). Finally, the monetary savings to our legal system and U.S. economy cannot be overstated (Florence et al., 2016).
Strategies to integrate controlled substance monitoring data into provider practice include
- funding research to optimize data integration of multiple database systems;
- including practitioners in the software development process;
- providing real time usable data that is in an easily readable format;
- ongoing training with follow up videos and tip sheets;
- creating alerts to providers for patients who are at high risk for opiate abuse;
- assisting patients into drug rehab upon noticing suspicious trends; and
- delivering quarterly reports to providers on community drug trends and impact of database utilization (Green & Pfenning, 2015; Young et al., 2017).
References
29 F.S. § 401-253 (2017).
46 F.S. § 893-055 (2017).
Centers for Disease Control and Prevention. (2016). Drug overdose death data. Retrieved from https://www.cdc.gov/drugoverdose/data/statedeaths.html
Centers for Disease Control and Prevention. (2017). Prescription opioid overdose data. Retrieved from https://www.cdc.gov/drugoverdose/data/overdose.html
Delcher, C., Wagenaar, A. C., Goldberger, B. A., Cook, R. L., & Maldonado-Molina, M. M. (2015). Abrupt decline in oxycodone-caused mortality after implementation of Florida’s prescription drug monitoring program. Drug and Alcohol Dependence, 150, 63-68. doi: http://dx.doi.org/10.1016/j.drugalcdep.2015.02.010
Florence, C. S., Zhou, C., Luo, F., & Xu, L. (2016). The economic burden of prescription opioid overdose, abuse, and dependence in the United States, 2013. Medical Care, 54(10), 901-906.
Green, S. L., & Pfenning, S. (2015). Optimizing the use of state prescription drug monitoring programs for public safety. Journal of Nursing Regulation, 6(3), 4-10.
McAllister, M. W., Aaronson, P., Spillane, J., Schreiber, M., Baroso, G., Kraemer, D.,…Gray-Eurom, K. (2015). Impact of prescription drug-monitoring program on controlled substance prescribing in the ED. American Journal of Emergency Medicine, 33, 781-785. doi: http://dx.doi.org/10.1016/j.ajem.2015.03.036
United States Department of Health and Human Services. (2017). Trump administration awards grants to states to combat opioid crisis. Retrieved from https://www.hhs.gov/about/news/ 2017/04/19/trump-administration-awards-grants-states-combat-opioid-crisis.html
Young, H. W., II, Tyndall, J. A., & Cottler, L. B. (2017). The current utilization and perceptions of prescription drug monitoring programs among emergency medicine providers in Florida. International Journal of Emergency Medicine, 10(16), 1-6. doi: 10.1186/s12245-017-0140-0
