Gossip-fanatics and tabloid-followers know just how many celebrity deaths can be attributed to prescription drug abuse. Some of the most notorious cases include Playboy Playmate Anna Nicole Smith, actor Heath Ledger and most recently, Michael Jackson. Unfortunately, prescription drug abuse is a problem affecting many more people than those covered by paparazzi.

Much of the abuse surrounding prescription drugs involves "doctor shopping," when patients see multiple doctors to receive more than one prescription. Typically, these individuals will either abuse the prescriptions themselves, or sell to others.

To date, 40 States have passed legislation to allow Prescription Drug Monitoring (PDM) programs, but only 34 are operating. The positive effects of PDM programs enacted in states have been widely identified. There have been significant decreases in per capita supply of prescription pain relievers and stimulants, which in turn reduces the probability of abuse of these drugs.

The purpose of such statewide PDM programs is to assist doctors in identifying individuals who abuse drugs, and eliminating their access to them. However, many states have reported that after implementing a drug monitoring program, patients tend to move their "doctor shopping" to bordering states. For example, in the Washington Metropolitan area, drug abuse patients have the ability to go to multiple states and access illegal prescriptions without fear of an interoperable database system. Due to this, there is now a push to extend these programs beyond state lines.

In 2005, President Bush enacted the National All Schedules Prescription Electronic Reporting Act (NASPER) to promote and fund state programs and advocate for a federal PDM database. At the time, no acts to implement the bill took place.

The National Health Information Technology Conference was held at the Massachusetts Health Data Consortium in April 2010. INPUT was represented by one of our analysts, who reported that talk of a national PDM program was one of the major topics discussed. Now, NASPER proponents are preparing to file for reauthorization of the bill with Congress, the effects of which should allow states to create and standardize PDM programs nationwide.

INPUT is very involved in tracking states that are in the first stage (passing legislation) second stage (acquiring/enacting the program) and third stage (re-bidding a PDM program contract) of authorizing PDM programs. Here are a few PDMP opportunities INPUT is tracking:

In Wisconsin, legislation has passed the Legislature. The program is awaiting Governor Jim Doyle's signature (follow here).

Maryland has not passed legislation. The state secured $50,000 from the Harold Rogers Prescription Drug Monitoring Fund in the BJA in January 2010.

In Georgia, the Senate recently defeated Legislative Bill H.R. 614, which would have established a PDMP for the state. However, the House of Representatives may try to attach the bill to other legislation in order to move forward with the state PDMP. Input is monitoring the state's progress here.

In Montana, no legislation has been brought to the Legislature. State Attorney General Steve Bullock says he will propose legislation during the next legislative session.

South Dakota recently passed a bill to create a statewide database. INPUT is monitoring for the release of a RFP here.

In Missouri,, despite attempts to move towards a state PDMP, there has been no legislation.

For the industry, vendors will see a greater need for state interoperability within geographic regions. For example, Tennessee borders Missouri, Kentucky, Virginia, North Carolina, Georgia, Alabama, Mississippi and Arkansas. A statewide PDM program for Tennessee will positively affect the state. However, a "spillover" effect of doctor shopping into the bordering states may be something to watch, and in turn, prepare for. Nationally, it is difficult to catch a criminal without the cooperation of involved states. This holds true for drug abusing criminals as well. If a state-only program is employed, it is difficult to catch criminals who find loop-holes with PDM programs.

In the future, it can be concluded that a national PDM program will be necessary to put an end to some forms of drug abuse. At a time when many database systems are becoming interoperable, many questions of authority are coming up (state vs. federal), and must be answered before they are truly effective. The issue of privacy is one of the greatest opponents of the PDM program. Therefore, database security could become the most important aspect of the PDM program's procurement requirements in the future.

Further INPUT resources for PDM Programs include information on the National All Schedules Prescription Electronic Reporting Grant, The Harold Rogers Prescription Drug Monitoring Program , and the Prescription Drug Monitoring Vertical Profile. And finally, the Health and Human services Department's new grant program is also looking to establish funding to help states create PDM programs. HHS should be making their first awards by September 2010.