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Letters: Opioids in Massachusetts

August 22, 2016 I am confused with the alleged plaudits Massachusetts is self-reporting secondary to this new statute which "requires a seven-day supply limit on initial opioid prescriptions" ("Massachusetts Law Sets Limited on Opioid Prescriptions," April 4 ADA News).

It appears that Massachusetts has confused the dispensed amount with the signa or label of patient directions.

Prescribers understand that different patients, or even the same patient, will take differing amounts of an analgesic on different days, thus the pro re nata or "as needed." It is impossible for any prescriber to know exactly what a seven-day amount for a particular patient, especially a new one, is going to be.

Further, the new law "requires doctors to check the Prescription Monitoring Program database" before prescribing opioids. That may sound like good policy, but it is now a meaningless exercise. Checking Prescription Monitoring Program data, ostensibly to help limit drug diversion, one now can confirm that dispensed amounts have all changed to "days" rather than the actual quantities written for and theoretically dispensed.

Why would Prescription Monitoring Program regulators not list the true amounts of the drugs dispensed? If the amounts prescribed are not listed, other than "days," it is impossible to know if the prescription was filled accurately.

Incredibly, this change is intentional.

The reason Prescription Monitoring Program reported for not listing the amounts of drugs dispensed is that when practitioners suspect they personally are being investigated on drug diversion related issues, the Prescription Monitoring Program data base could be accessed and then office records altered to mirror what is iterated in the data base. In order to avoid allowing practitioners to actually see what pharmacies report is dispensed, the Prescription Monitoring Program sites now incorporate a confidential formula to convert the definite dispensed amounts into indefinite "days."1  

The original purpose of Prescription Monitoring Program-type data banks was to help doctors prevent diversion.2 Now, some might say doctors have morphed from diversion preventers to targets. It now seems that the only way for doctors to be assured of following the law is to dispense not a number of tablets but a number of days.

Daniel L. Orr II, D.D.S., Ph.D., J.D., M.D.
Las Vegas

1. Orr D. A Good Rx Redux, NV Dent Assn J, 2015;17(3):4-5
2. Orr D. A Good Rx, NV Dent Assn J, 2010;12(2):4-5

Editor's note: The American Dental Association is urging Congress to pass the Comprehensive Addiction and Recovery Act, which would authorize funds to improve the design and operation of state prescription drug monitoring programs. The ADA is also working with the American Medical Association Task Force to Reduce Prescription Opioid Abuse to improve the design and operation of prescription drug monitoring programs across the country.

Those with specific questions about the data collected can contact their state prescription drug monitoring program. A list of prescription drug monitoring programs by state is available at NASCA.org.