Tracking and Monitoring Strategies

Tracking and monitoring strategies help law enforcement and regulatory agencies detect "doctor shoppers" and identify prescribers who have unusual prescribing practices. The best known example of tracking and monitoring interventions are prescription drug monitoring programs (PDMPs), which are electronic databases that track prescribing and dispensing of opioid analgesics and other controlled substances have been implemented in many states. In those states with a functioning PDMP, there were significantly lower increases in the number of Oxycodone shipments, intentional exposures to NMUPDs, and treatment admissions associated with NMUPD. Other types of tracking and monitoring strategies include those focused specifically on prescriber behavior, such as regulations requiring physical exams, and regularly scheduling in-person visits with patients at risk for NMUPD. Another strategy requires that patients show identification to pharmacists before dispensation. To date, there has been limited studies examining the effectiveness of tracking and monitoring regulations in reducing NMUPD; however tracking and monitoring strategies are more likely to be effective if they are:

  • Implemented in conjunction with other state initiatives and enforcement strategies. For example, model pain clinic regulations (i.e., required state registration, mandatory use of the prescription drug monitoring program, prohibition of physicians dispensing drugs from their offices) when implemented with increased enforcement have been associated with reductions in drug diversion rates and overdose deaths.1
  • Mandated and proactive. States that require prescribers and pharmacists to participate in their prescription drug monitoring programs (PDMPs) have lower incidence of doctor shopping behavior, and reduction in the overall dispensing of controlled substances.2 In addition, the greatest reductions in per capita supply of prescription pain relievers and stimulants occurred in states with a proactive PDMP rather than one that is reactive.3

Another tracking and monitoring strategy is Triplicate prescription programs (TPPs) which require physicians to issue prescriptions for certain controlled substances using multiple copy forms, with the extra copies either retained for record-keeping purposes or submitted to monitoring agencies. Some states implemented TPPs as precursors to PDMPs. The New York TPP demonstrated significant reductions in problematic benzodiazepine use, pharmacy hopping, and non-problematic benzodiazepine use with decreases mostly among African American individuals.4

Tracking and monitoring strategies, summarized here, include the following:

1 Johnson, H., Paulozzi, L., Porucznik, C., Mack, K., & Herter, B. (2014). Decline in drug overdose deaths after state policy changes—Florida, 2010–2012. Morbidity and Mortality Weekly Report, 63(26), 569–574. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6326a3.htm

2 PDMP Center of Excellence. (2014). Mandating PDMP participation by medical providers: Current status and experience in selected states. Waltham, MA: Brandeis University.

3 A proactive PDMP identifies and investigates potential cases of misuse, generating unsolicited reports whenever suspicious behavior is detected. A reactive PDMP generates reports only in response to a specific inquiry made by a prescriber, dispenser, or other party with appropriate authority. Simeone, R., & Holland, L. (2006). An evaluation of prescription drug monitoring programs. Washington, DC: U.S. Department of Justice, Office of Justice Programs. Retrieved from http://www.simeoneassociates.com/simeone3.pdf

4 Pearson, S.-A., Soumerai, S., Mah, C., Zhang, F., Simoni-Wastila, L., Salzman, C., . . . Ross-Degnan, D. (2006). Racial disparities in access after regulatory surveillance of benzodiazepines. Archives of Internal Medicine, 166(5), 572–579. Retrieved from https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/409923