Many doctors aren't checking Florida database for opioid control, study finds

Liz Freeman
Naples Daily News
Pain pills are causing an addiction epidemic in Florida.

University of Florida researchers have found that a state prescription drug database — meant to help curb opioid abuse and "doctor shopping" — is being used by only a limited number of health care providers and might fall short of goals.

The analysis by researchers at UF’s College of Medicine, published Monday, Nov. 20, in the Journal of Opioid Management, found 21 percent of physicians and 57 percent of pharmacists have registered with the state’s prescription drug database to check patients' records.

The Obama administration had set a goal that 25,000 physicians and 31,000 pharmacists use the database. The program is called the Prescription Drug Monitoring Program, PDMP.

Checking the database is voluntary, with the idea that doctors and other providers planning to write a new prescription could see whether a patient had a history of using pain medications or was doctor shopping for prescriptions.

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Providers who prescribe and dispense controlled substances are required to report to the database within seven days of dispensing opioids, according to the Florida Department of Health. The state agency runs the drug-monitoring database program, which became operational in 2011.

The Legislature had passed a bill in 2009 to create the Florida drug database program in response to the pain pill epidemic and widespread diversion by abusers. At the same time, the Legislature passed measures to curtail pill mill clinics.

According to the U.S. Drug Enforcement Administration, Florida had more than 900 unregulated pain pill clinics in 2010, which employed 90 of the top 100 oxycodone-dispensing doctors in the United States. In addition, about 10 people a day were dying of prescription drug overdoses, primarily from oxycodone abuse.

According to the independent nonprofit Florida PDMP Foundation Inc., established to provide support to the program, 41,581 health care providers with DEA licenses to prescribe controlled substances have registered to use the database, out of total of 161,000 statewide who could register. The UF research was focused strictly on physicians and pharmacists.

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“The database has reduced doctor shopping by 75 percent,” said Bob Macdonald, executive director of the foundation. “That is a major thing.”

In addition, he said 3.5 million prescriptions are entered monthly into the database since 2011, when it got up and running, he said.

The UF research findings show there are opportunities to encourage more physicians to use the database, said Chris Delcher, an assistant professor of health outcomes and policy at UF’s College of Medicine. Unlike Florida, 27 other states make database registration mandatory.

“Our focus is mostly on trying to get voluntary buy-in by showing how valuable the database is from a public health perspective,” Delcher said.

The research aimed to determine how many more physicians and pharmacists were signing up to use the database from 2013 through 2016. The analysis found a spike of new registrations when Medicare and Medicaid tied payments to “meaningful use” of electronic medical records. Still, registration did not appear to translate into increased use to look up records, the UF researchers found.

“Utilization of the database will reduce prescription drug abuse and reduce drug overdose and death,” Bruce Goldberger, director of UF’s Health Forensic Medicine program and study author, said in a news release.

Gov. Rick Scott in May declared a public health emergency over opioid use; doing so could help draw millions of dollars in federal funding to combat the crisis.

In September, Scott said he would propose major legislation in 2018 and commit about $50 million to fight the problem.

Scott is proposing:

  • A three-day limit on prescribed opioids.
  • Beefed-up regulations with the prescription-drug monitoring program.
  • Tougher actions against unlicensed pain management clinics.
  • A requirement that all health care providers look up records of patients before prescribing or filling prescriptions.

The UF research found that pharmacists are more likely than physicians to use the database, yet physicians who use it do so more than pharmacists. Physicians averaged 58 inquiries, compared with 36 inquiries by pharmacists. An inquiry is when an individual’s controlled-prescription history is requested electronically.

The researchers said there are several reasons physicians are not using the database. Those reasons include specialties in which pain medications are less likely to be prescribed, time constraints or the database not being integrated with electronic medical records.