Less than half of Iowa prescribers in program to cut opioid spread

DES MOINES - Only two in five Iowa doctors and other medical professionals who prescribe opioids are registered with a state program that is designed to help address an opioid addiction epidemic that is killing hundreds of Iowans each year.

The state is in the process of updating that system, called the Iowa Prescription Management Program, to make it more streamlined and user-friendly. State officials hope the $200,000 upgrade will encourage more physicians to participate in the program.

'Ultimately we want the system to be utilized to the fullest extent possible, and we realize from the roadblocks some of the reasons it's not being utilized is it's just too onerous to be used,” said Andrew Funk, executive director of the state pharmacy board that is overseeing the upgrade.

'We believe the upgraded software will make it easier to use, make the data more user-friendly, easier to read,” Funk said. 'We want it utilized. We want more prescribers signed up for it.”

Opioids were involved in 848 deaths in Iowa from 2013 to 2015, according to the federal Centers for Disease Control and Prevention.

Some individuals attempt to obtain extra painkillers by going to several physicians to obtain multiple prescriptions, a practice that is called doctor shopping. The individuals then sell the painkiller illegally to make a profit or take them to feed an addiction.

In 2016, 232 individuals in Iowa attempted to obtain Schedule II prescriptions - including but not limited to oxycodone, opium, morphine, codeine and methamphetamine - from five or more prescribers or pharmacies, according to state data. That number peaked at 303 in 2014.

Iowa's Prescription Management Program was implemented in 2009 to prevent doctor shopping.

When a patient is prescribed opioid pain medicine, that information is entered into a system that can be accessed by registered doctors and other prescribers. So prescribers can access the program to see if a patient already has received prescription opioids.

But only 42 percent of Iowa prescribers were registered with the program in 2016, according to the pharmacy board's annual report.

Some doctors say the program is time-consuming and difficult to navigate. Dennis Tibben, director of government affairs for the Iowa Medical Society, said the program only recently added records from neighboring states, and reporting time is slow because prescribers are required to report only on a weekly basis, unlike other states that require daily reporting.

'The limitations of the current system, especially the difficulty navigating the program and the lack of integration with (electronic health records), have led many prescribers who initially tried to utilize the PMP to not continue doing so and led many to not start in the first place,” Tibben said.

Tibben also said the participation rate is low in part because some doctors and other prescribers have focused practices for which they would not prescribe opioids, thus making it unnecessary for them to register with the program. And some practices have designated professionals who check the program for each day's patients, negating the need for every physician in the building to be registered with the program and check on each patient during the appointment.

Still, Tibben said he hopes the pending upgrade will improve the system and make it more attractive to more prescribers.

'While we'll never get to 100 percent prescriber registration, once some of these upgrades are made to make the system more functional and integrated, and make the records more complete, I expect utilization will grow at a more rapid pace,” Tibben said.

Funk said that is one of the goals of the program upgrade, to make it more easily navigable for prescribers. Funk said there is no official timeline for sending the upgrade project out for bids, but a request-for-proposal is being drafted and he hopes to have the new system installed and operating by the end of the calendar year.

'That's my hope,” Funk said. 'We hope we can get moving on this as quickly as we can.”

Similar efforts are underway in other states. In Massachusetts, new technology was implemented this past August, along with a new state law requiring doctors to check the program before prescribing the most addictive opioids, according to the nonpartisan publication Governing. Roughly 70 percent of doctors signed up for the new database in the first six months, the magazine reported.

John Forbes, a Democratic state lawmaker and pharmacist from Urbandale, said the prescription management program is a key tool in the battle against opioid overdoses and related deaths. He, too, hopes the pending upgrades persuade more prescribers to participate.

'It's important that doctors have this tool in place, and that it's a user-friendly tool,” Forbes said.

Forbes supports other legislative measures that have been introduced with the goal of strengthening the program but have not gained full support of state lawmakers.

One would require prescribers to register with the program - but not mandate that they use it. Another would require registered prescribers to report prescription information daily, instead of weekly as is currently required.

Forbes said he is hesitant to create mandates for health care professionals, but he also thinks it is important that prescribers use best practices, including using a program designed to protect individuals from opioid overdoses. He said he plans to work on both proposals and attempt to garner bipartisan support during next year's legislative session.

'I don't like to pass legislation that mandates to people how they should practice medicine,” Forbes said. 'But in some cases, if they're not doing that, then I think we have to step in and make sure the public is protected.”

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