Colorado Medical Society

http://dev.cms.org/articles/dora-issues-600-notifications-on-potential-doctor-shopping/

DORA issues 600 notifications on potential doctor-shopping

Tuesday, November 18, 2014 03:00 PM

More than 600 prescribers and pharmacies in Colorado received a notification on Oct. 30 from the Colorado Prescription Drug Monitoring Program (PDMP) that a patient they treat obtained potentially dangerous amounts of controlled substances from multiple prescribers and pharmacies.

According to a press release from the Department of Regulatory Agencies (DORA), one patient obtained prescriptions from 11 different prescribers and 10 different pharmacies within 30 days, amounting to potentially harmful quantities of potent prescription drugs. Another obtained more than 1,600 pills of oxycodone and hydrocodone from multiple prescribers and dispensers in one month.

These “push-notices” are the first following legislation passed this year that allows the database to send information to health care prescribers and dispensers. The legislation also requires all DEA-registered medical board licensees to register a user account with the PDMP by Nov. 30, 2014, but does not require usage.

DORA asks practitioners receiving a push-notice to use their clinical judgment to determine the appropriate response.

“The primary benefit is that it increases the information physicians have about a patient’s behavior, which could potentially be deadly, and gives physicians choices,” said John Hughes, MD, chair of the CMS Committee on Prescription Drug Abuse. “They can do education or get the patient into a safer pain setting where a pain physician monitors their medications and brings other treatments. It enhances patient safety.”

“On the surface it could be construed as being punitive to patients but, looking beyond that, it gets patients and their doctors to have a real discussion about pain and create an interdisciplinary pain program rather than relying too much on the medication,” he said.

The PDMP is a statewide database of controlled substances dispensed to Colorado patients. The information is made available to prescribers and pharmacists. It was created in 2005 to help curb doctor-shopping, a tactic used to secure prescription drugs from multiple sources for misuse, abuse or diversion, but this is the first year push-notices were authorized.

Lauren Larson, director of DORA’s Division of Professions and Occupations, which administers the PDMP, said in the press release that states that have implemented push-notices have experienced up to a 74 percent drop in doctor-shopping. “The PDMP push-notices help to alert health care practitioners when there may be a problem, and to coordinate care when a practitioner may not otherwise know someone else is prescribing to the same patient.”

The Colorado Consortium for Prescription Drug Abuse Prevention, created in 2013 by Gov. John Hickenlooper, is spearheading the statewide response to the prescription drug abuse epidemic. The Colorado Medical Society is an active participant in the consortium. CMS supports greater use of the PDMP as one of many strategies to reduce opioid abuse and misuse, and supports the efforts of the Colorado State Board of Pharmacy to make the PDMP more user-friendly for physicians.