Misuse of prescription drugs is second only to marijuana as the nation’s top illicit drug problem, and in some previous studies Arkansas ranked first in the nation in the percentage of youths aged 12 to 17 abusing prescription pain relievers, according to the National Survey on Drug Use and Health. In 2008, Arkansas ranked the second highest nationally in overall drug overdose deaths with 5.1 per 100,000 deaths resulting from nonmedical use of opioid pain relievers.

The state’s new Arkansas Prescription Monitoring Program (PMP) instituted in March 2013 is already making a big difference addressing that public health problem by reducing doctor shopping and pharmacy shopping, going from one doctor or pharmacy to another to get prescriptions filled for the same type of medication.

The number of flagrant doctor shoppers in the state had decreased 60 percent from the beginning of March 2013 through the end of the year.

“That is absolutely fantastic,” said Denise Robertson, PD, administrator of the Arkansas PMP. “The system is running well and our users are pulling information and communicating it to each other. PMP data is unique and provides an important tool for identifying questionable activity with respect to prescription drugs, such as doctor and pharmacy shopping, prescription fraud, and problematic prescribing. The incorporation of information from the Arkansas PMP into current healthcare practice can be instrumental in reducing the devastating effects of prescription drug abuse in Arkansas.”

At nearly a year into the program, there were 9.6 million prescription records in the database. Controlled substance prescription data is collected from both in-state pharmacies and from out-of-state pharmacies that are licensed to deliver prescriptions to Arkansas residents. Pharmacies uploaded six months of back data before March 1, so there are now about a year and a half of records.

By January there had been about 400,000 reports requested by pharmacists and prescribers.

“That is a lot,” Robertson said. “They are using it. In addition to preventing people from getting multiple prescriptions that are not justified, the good thing about the program is that users can see other practitioners involved, and can get them involved in patient care and referral to treatment, if needed. The feedback we are getting is that people find the automated system easy to use and very helpful. Physicians are using it in their drug treatment programs, and they love it. They can see the patterns of usage in their patient, seeing how consistent they are in refilling prescriptions.”

Feedback from users is that the system is very easy to use. Software used by pharmacies can automatically upload the information into the database so no extra, time consuming steps are needed to comply. A report is created weekly.

In addition to reducing problematic use, the PMP can also verify legitimate use. Robertson said it takes suspicion away from a person who really needs the medication so they don’t have to be worried about getting their pain meds. And physicians can feel assured they are writing a prescription for a legitimate purpose.

Arkansas chose a software company that already operated PMPs in 22 other states.

“They are very knowledgeable in doing PMPs already,” Robertson said. “The program combines information from different pharmacies and pulls people together by names, alias, birthdates and addresses. When a prescription comes in, a pharmacist looks into the system and sees prior fillings and prescriptions for that person so the pharmacist can make an informed decision if it is the proper time to fill the prescription, if there are duplications, and if there are potential drug interactions. The pharmacist brings up the information before filling the prescription.”

The program can reveal people who are consistently running out of pills early, and asking for a refill before it is time. It also shows if the patient has visited another practitioner for the same type of medication.

The program also provides recommendations for physicians on dealing with patients who may be abusing prescription drugs through resources links such as www.samshsa.gov. Also, the website www.arkansaspmp.com has signage pharmacies and clinics can put up at their intake and outtake windows stating, “We participate in the prescription monitoring program.”

The PMP is also an effective tool for emergency room physicians designed to reduce prescription drug abuse. These physicians frequently see patients about whom they have little previous information.Jim Myatt, PD, branch chief, Pharmacy Services, Arkansas Department of Health, said a number of groups in the state came together to get the PMP legislation passed in 2011. “I have to give credit to State Drug Director Fran Flener, who convened a group that came together in 2010 to try to address the prescription drug abuse problem,” Myatt said. “The legislation had been tried previously a couple of times without success. She brought together a big group of interested parties, got consensus and the legislation passed due to her efforts.”

Flener said while the program is user friendly, during the 2015 legislative session there will be efforts to improve the legislation. Any dispensers or prescribers with complaints or suggestions for improvement should contact the PMP advisory committee.

While participation in the program is mandatory in some states, it is voluntary in Arkansas. Flener is hoping that a lot more subscribers and prescribers will sign up to increase the reach and effectiveness of the program.

“We’re trying to get more people aware that the program is there and to use it,” she said.