Recommendations to Improve West Virginia's Prescription Drug Monitoring Program

Opioid overdose deaths have increasingly become a major concern in the United States. Although there has been some slight fluctuation in numbers over the years, the number of annual deaths totaled more than 70,000 in 2019 (National Institute on Drug Abuse, 2021). While every state has contributed differently to this total, West Virginia had the highest number of opioid-involved overdose deaths per 100,000 persons as of 2018 (National Institute on Drug Abuse, 2020). Providers in West Virginia also wrote more opioid prescriptions compared to the national average of 51.4 per 100 persons at 69.3.

In order to combat the issue of opioid overdose, policymakers passed the West Virginia Drug Control Policy Act in 2017, which formed the Office of Drug Control Policy (ODCP). The office was designed to increase overdose surveillance in the hopes that it would allow the state to strengthen their response. It also placed limits on opioid prescribing and has made overdoses a notifiable condition (WVDHHR, n.d.). More recently, the ODCP implemented a ‘free naloxone day’ in the fall of 2020. A number of schools, health systems, and other organizations worked together to hand out Narcan and educate people on how to use it at over a dozen locations (WVDHHR, n.d.). The initiatives created by the office proved to be helpful and West Virginia saw declining numbers of overdose deaths in the year following its inception. In addition, West Virginia utilizes a prescription drug monitoring program (PDMP) to improve opioid prescribing. The database tracks controlled substance prescriptions and allows prescribers to view a patient’s history. If used correctly, PDMPs can prove to be a very strong tool in reducing opioid overdose deaths.

Recommendation 1

Implement at a mandate that requires prescribers to check West Virginia’s PDMP before being able to prescribe opioids.

The mandate would force prescribers to utilize the Controlled Substances Monitoring Program (CSMP) and review a patient’s medical history prior to issuing any opioid prescription. The aim is to have prescribers better familiarize themselves with each patient and their previous opioid usage in order to make an informed decision regarding if and how much should be prescribed. Currently, physicians are only required to view the patient’s history in CSMP before any initial prescription, but this mandate would require a check each and every time opioids are to be prescribed. Doctor shopping and overdoses could be avoided if physicians take the extra step in reviewing the PDMP report (Purington, 2019).

Recommendation 2

Integrate PDMPs into electronic health record systems (EHR).

Allowing prescribers access to West Virginia’s PDMP via a hospital’s EHR allows for better clinical decision-making and a high level of workflow integration (Myers & Searcy, 2019). With increased interoperability, providers are able to weigh patient and prescriber data across various health organizations. Patient prescription information can also be increasingly exchanged across such health organizations if more hospitals were to be connected through this single workflow. This could even stretch nationally and allow prescribers to see if high-risk patients are driving across state lines to seek opioids.

Recommendation 3

Permitting physicians to give other allied health professionals access to PDMPs.

This policy would give leave to professionals, such as nurses, to be able to review patients PDMP report. They would also be able to enter patient data and update prescription information should the physician deem opioid use to be acceptable. Many providers find it time consuming and frustrating to constantly have to flit through the database for reports and such, especially considering West Virginia currently requires PDMPs to be updated every single day. While physician assistants and advanced practice nurses are granted access to the database, it would be hugely beneficial to expand the access to all registered nurses in order to increase efficiency and accountability. Delegating the responsibility of updating the PDMP to a nurse on a patient’s care team allows for another set of eyes and attention to detail, which could help reduce over-prescribing to a high-risk patient.