Overview: Maryland Prescription Drug Monitoring Program

August 2nd, 2017 by Michael Tennison

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Deaths from drug overdoses continue to rise across the nation.  From 1999 to 2014, overdose deaths increased nearly three-fold, over 60% of which involved an opioid in 2014.[1]  In Maryland, 89% of intoxication deaths in 2016 involved opioids, increasing 70% since 2015 and almost quadrupling since 2010.[2]

[3]

One response, adopted by 49 states, the District of Columbia, and Guam, is to track the lawful prescription and dispensing of controlled substances.[4]  The Maryland Prescription Drug Monitoring Program (“PDMP”) [5] was created in 2011 to provide informational assistance to professionals in health care, public health, and law enforcement about the prescription and dispensing of controlled dangerous substances (“CDS”).[6]

Administered by the MDH Behavioral Health Administration, the PDMP:

(1) Assist[s] prescribers, dispensers, and public health professionals in:

(i) The identification and prevention of prescription drug abuse; and

(ii) The identification and investigation of unlawful prescription drug diversion; and

(2) Promote[s] a balanced use of prescription monitoring data to assist appropriate law enforcement activities preserving the professional practice of health care providers and the access of patients to optimal pharmaceutical care.[7]

All Maryland-licensed pharmacists and practitioners authorized to prescribe CDS must register with the PDMP through the Chesapeake Regional Information System for our Patients (“CRISP”).[8]  All dispensers must report, for each filled CDS prescription, identifying information about the drug, patient, prescriber, and dispenser.[9]  A dispenser who fails to submit required information to the PDMP is subject to civil penalties.[10]

Although the PDMP was established years ago, its use will soon be required: starting on July 1, 2018, prescribers must consult a patient’s PDMP data before prescribing an opioid or benzodiazepine and every 90 days during the course of treatment with CDS.  Pharmacists must review a patient’s PDMP data, prior to dispensing a CDS, if they reasonably believe the patient seeks the drug for non-medical use.[11]  Prescribers and pharmacists may delegate PDMP access to staff working in the same practice or facility.[12]

There are some exceptions for when the PDMP must be used, however. Prescribers do not need to consult request PDMP data if the opioid or benzodiazepine is prescribed for 3 or fewer days of use; for treatment of “cancer or cancer-related pain;” or for other patients who meet certain criteria. Additionally, prescribers do not need to request PDMP data if prescribing to an individual to treat or prevent acute pain for less than 14 days following a surgical procedure using general anesthesia; a fracture; significant trauma; or childbirth.[13]

Prescribers may not be required to comply with PDMP provisions under other exceptions, as well, including when electronic access is not operational or monitoring data cannot be access due to “a temporary technological or electrical failure.”[14]information must be kept confidential and privileged, and relevant information may be accessed only by specified individuals, including, among others, prescribers; dispensers; and federal, state, and local law enforcement agencies; MDH agencies; and the PDMPs of other states.[15]  CRISP provides authorized users with secure, online access to PDMP information and other clinical data.[16]  A person who misuses, discloses, or attempts to access PDMP data inappropriately is subject to penalties, including fines and/or imprisonment, or disciplinary action by the appropriate licensing body.[17]

The Maryland PDMP is one tool among many in a multi-pronged legal, scientific, medical, and law enforcement approach to identifying and ameliorating behaviors associated with overdose deaths.

[1] Rose A. Rudd, Puja Seth, Felicita David,& Lawrence Scholl, Increases in Drug and Opioid-Involved Overdose Deaths – United States, 2010-2015, 65 Morbidity and Mortality Weekly Rep. 1445 (2016), https://www.cdc.gov/mmwr/volumes/65/wr/mm655051e1.htm.

[2] Md. Dep’t of Health, Drug- and Alcohol-Related Intoxication Deaths in Maryland, 2016 (June 2017), https://bha.health.maryland.gov/OVERDOSE_PREVENTION/Documents/Maryland%202016%20Overdose%20Annual%20report.pdf.

[3] Id.

[4] PDMP TTAC, Prescription Drug Monitoring Frequently Asked Questions (FAQ), http://www.pdmpassist.org/content/prescription-drug-monitoring-frequently-asked-questions-faq (last visited July 27, 20017).

[5] Md. Code, Health-Gen. Art., § 21-2A (2017).

[6] See Md. Code, Crim. Law Art., § 5-101(g)(1) (defining CDS as “a drug or substance listed in Schedule I through V” or “an immediate precursor to a drug or substance listed in Schedule I through Schedule V” that meets certain requirements).

[7] Health-Gen. § 21-2A-02. The Maryland Department of Health Notice of Final Action implementing PDMP regulations was published in the Maryland Register in December of 2012. Md. Code Regs. 10.47.07 (2012).

[8] Health-Gen. § 21-2A-04.1.

[9] Md. Code Regs. 10.47.07.03 (2015). “Dispensers” include “a person authorized to dispense a monitored prescription drug to a patient,” including a nonresident pharmacy. Health-Gen. § 21-2A-01 (d) .

[10] Health-Gen. § 21-2A-09(a).

[11] Health-Gen. § 21-2A-04.2. “Prescribers” means “a licensed health care professional authorized by law to prescribe a monitored prescription drug.” Health-Gen. § 21-2A-01 (j).

[12] Health-Gen. § 21-2A-04.3.

[13] Health-Gen. § 21-2A-04.2(b).

[14] Health-Gen. § 21-2A-04.2(c).

[15] Health-Gen. § 21-2A-06.

[16] CRISP, https://www.crisphealth.org/ (last visited July 27, 2017).

[17] Health-Gen. § 21-2A-09(b).

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