Evolution and convergence of state laws governing controlled substance prescription monitoring programs, 1998-2011

Abstract

Objectives: We sought to collect and characterize all laws governing the operation of prescription monitoring programs (PMPs), state-level databases that collect patient-specific prescription information, which have been suggested as a tool for reducing prescription drug overdose fatalities.

Methods: We utilized a structured legal research protocol to systematically identify, review, and code all PMP statutes and regulations effective from 1998 through 2011. These laws were then abstracted along eleven domains, including reporting provisions, data sharing, and data access.

Results: PMP characteristics vary greatly among states and across time. We observed an increase in the types and frequency of data required to be reported, the types of individuals permitted to access PMP data, and the percentage of PMPs authorized to proactively identify outlier prescribers and patients. As of 2011, 10 states required PMPs to report suspicious activity to law enforcement, while only 3 required reporting to the patient's physician. None required linkage to drug treatment or required all prescribers to review PMP data before prescribing. Few explicitly address data retention.

Conclusions: State PMP laws are heterogeneous and evolving. Future studies of PMP effectiveness should take these variations into account.

FIGURE 1—

Growth of States enacting prescription monitoring program legislation: United States, 1998–2011. Note. PMP = prescription monitoring program. The number of states with enabling legislation for prescription monitoring programs grew steadily from 1998 to 2011.

FIGURE 2—

Requirements for medicines in selected federal drug schedules to be included in state prescription monitoring programs: United States, 1998–2011. Note. PMP = prescription monitoring program. All prescription monitoring programs required data on Schedule II medicines to be submitted during the entire study period. By 2011 nearly all states also required Schedules III and IV, but only approximately half required reporting of Schedule V medications.