Gaps in State Prescription Monitoring

When I accessed a new patient’s state controlled substance prescription database recently I found no record of the methadone he claimed a local methadone maintenance program administered. The director of the state prescription monitoring program told me that 42CFR prohibits maintenance programs from reporting. Furthermore, the statute prohibits redisclosure, so even if methadone clinics require all patients to authorize disclosure to the database, the database could not include the information.

I wondered how, then, could 42CFR allow information about buprenorphine dispensed by pharmacies into the database. According to the law pharmacies enjoy exempt status.

Apparently, the Veterans Administration provides another loophole. Controlled substances dispensed by VA pharmacies may not appear in the state databases either.

This failure to provide complete information dangerously deceives prescribers. When we rely on the database we risk unknowingly prescribing lethal doses or combinations of drugs. We should close the loopholes before we kill (more) patients as a result of incomplete information. We need to amend 42CFR to allow or require reporting of all methadone prescriptions to state databases. The VA should also implement policy to report.

These changes would leave yet another loophole: Prescribers in one state may not have access to the databases of other states where patients obtain drugs. We need either a national database or sharing among states if we are to prevent overdose deaths.

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