The federal government is expanding prescription drug monitoring programs and will link state systems, the White House announced May 11. The plan is part of a national strategy to tackle America's drug problem, and clinicians can expect increased monitoring of opioid prescriptions and other medications.

The new prescription monitoring program is not yet designed, but the Obama administration says it would like to develop a single system linking states to electronic health records.

"The goal is to have one system that can be easily used by all parties and will maintain appropriate confidentiality safeguards for patients," says the White House report. "Once a standardized and compatible system is designed, database specifications will be codified using American Society for Automation in Pharmacy standards for electronic prescription formatting."

President Barack Obama's administration wants a single prescription monitoring program across states.

An estimated 20 million Americans currently use drugs illegally. According to officials, each day, another nearly 8000 people consume an inappropriate drug for the first time.

Drug-induced deaths have reportedly almost doubled in the last decade. The federal government is setting ambitious five-year goals to reduce this number and other drug-related morbidity.

Officials from the office of national drug policy are making plans to meet with people from state prescription drug monitoring programs, the American Medical Association, and interested agencies to discuss the proposed system.

Death Rates Nearly Doubling

Speaking here at the American Pain Society 29th Annual Scientific Meeting before the federal announcement, delegates raised concerns about current prescription monitoring.

"This has a chilling effect on prescribing," said Aaron Gilson, MD, from the University of Wisconsin at Madison. "There has been a stigmatization of opioid prescriptions, and many clinicians have opted to avoid them altogether. In some instances, prescribers substitute for other nonindicated drugs."

Presenter Robert Twillman, PhD, from the University of Kansas, Lawrence, said this is a worrisome trend that researchers have already seen in the state of New York after new monitoring programs were put in place. "There is no doubt we saw a substitution effect in New York," he said.

Each day, another 8000 Americans consume an inappropriate drug for the first time.

Dr. Gilson pointed out that some in law enforcement have used the decrease in opioid prescriptions as evidence of the success of monitoring. "But this affords no indication of the effect on legitimate prescribing."

The Obama administration acknowledges that any new policy will have to strike a balance between minimizing inappropriate use of pharmaceuticals and maximizing their legitimate benefits.

Presenter Scott Fishman, MD, from the University of California at Davis in Sacramento, said he is concerned about well-intended prescription monitoring programs having unintended consequences.

June Dahl, PhD, from the University of Wisconsin School of Medicine and Public Health at Madison, said this is why it is important for clinicians to become better informed on these issues.

Well-Intended Programs, Unintended Consequences

"There is the potential for federal agencies to come down on you inappropriately in ways that will affect patient care," she warned at the meeting. "Physicians need to become significant voices in the conversation about prescription monitoring programs."

The physicians applauded the potential usefulness of prescription monitoring databases and called for education to teach users about the purpose of the information, requirements, and hoped-for potential.

"We need to decrease the diversion and abuse of controlled substances without violating patient privacy or interfering with legitimate medical practice," Dr. Dahl said.

The national drug control budget for next year will be $15.5 billion. This is a 3.5% increase. More emphasis will also be placed on early intervention and treatment services for people with drug problems.

The budget includes a more than $100 million increase for substance abuse and mental health services. The department will help train physicians to intervene in emerging cases of drug abuse. It will also expand specialty care for addiction. Military veterans can also expect to receive more money for substance use disorders and mental illness.

Dr. Gilson reports financial ties to Cephalon and Purdue Pharma. Dr. Twillman has worked with Merck. Dr. Fishman and Dr. Dahl have disclosed no relevant financial relationships.

American Pain Society (APS) 29th Annual Scientific Meeting: Abstract 316. Presented May 7, 2010.

Allison Gandey, Medscape Medical News © 2010 Medscape, LLC