Are you checking the PMP before prescribing an opioid analgesic or a benzodiazepine?

The Arizona Board of Pharmacy has just reported that more than half of health care practitioners who prescribed an opioid analgesic or a benzodiazepine in the last month did not check the PMP.

The Arizona Controlled Substances Prescription Monitoring Program (PMP) is the standard of care and best practice to ensure your patients are receiving appropriate and safe medications. It has proven to be one the most promising state-level interventions to improve opioid prescribing, inform clinical practice, and protect patients at risk.

There are many benefits to checking the PMP including:

• Patient Safety – Patients may see more than one prescriber; sometimes they forget to tell each provider about other medications they are taking, and sometimes they are engaging in “doctor shopping.” The PMP is an ideal tool to keep your patients safe and minimize diversion of prescription medication.
• Protection of DEA License- The MyRx function allows practitioners to view a list of all patients that received controlled medications under the practitioner’s DEA number.  This can help identify misuse of DEA numbers.
• Limit Prescriber Liability – Checking patient medication history is a good practice for ensuring the standards of care and limiting any liability involved with dangerous drug combinations or high-dose prescribing, especially if a patient is seeing more than one prescriber.
• Easier than Ever - Prescribers can appoint an office designee to access their patients’ medication history from the PMP, just like they do patient charts. This will cut down on prescriber time and still ensure patient safety and minimize liability concerns. In addition, technical support is available through the Arizona Board of Pharmacy to help you integrate the PMP into your electronic health record, or if you access the Health Current HIE Portal regularly, you can access the PMP via the Portal.

Compliance with PMP Laws

It is important for all dentists to understand and comply with Arizona’s legal requirements for prescribers to utilize the Controlled Substances Prescription Monitoring Program (PMP). Arizona Revised Statutes 36-2606 requires that before prescribing an opioid analgesic or benzodiazepine controlled substance listed in Schedule II, III or IV to a patient that prescribers shall obtain a utilization report from the PMP regarding the patient for the preceding twelve months at the beginning of each new course of treatment and at least quarterly while that prescription remains a part of the treatment. There are some exceptions, e.g. prescriptions for hospice patients, etc., so please refer to the statute for more information.

This law has been in effect since October 16, 2017. There is escalating attention by policymakers and regulators (like BODEX) on the low utilization rates of the PMP as required by law. More than half of prescribers who prescribed an opioid analgesic or a benzodiazepine in the prior month did not check the PMP. If you have not done so already, we strongly urge you to integrate routine checking of the PMP into your clinical practice.

There are several resources available to help you use the PMP and understand your prescribing requirements under Arizona law:

• Arizona Board of Pharmacy website pharmacypmp.az.gov for informative videos on PMP registration and usage.
• For information about Arizona’s opioid prescribing laws, visit AzRxEd.org to view a free continuing medical education (CME) program for healthcare professionals that provides the latest information about Arizona’s opioid laws and regulations, prescribing guidelines, and treatment options for opioid use disorder.

Exceptions to the law

Arizona Revised Statutes, 36-2606, Section H, Items 5 & 6 were not mentioned.  Section H lists situations that do not require accessing the PMP database. Item 5 states, “The medical practitioner is prescribing the controlled substance to the patient for no more than a 5-day period for an invasive medical or dental procedure or a medical or dental procedure that results in acute pain to the patient.” 

Item 6 (without direct quote), excludes no more than a 5-day period for an acute medical or dental injury or a medical or dental disease diagnosed in an emergency room.  I think these two exceptions are critical for the dental community of which to be aware.