RD394 - Virginia Prescription Monitoring Program 2018 Annual Report

Executive Summary:

The Virginia Prescription Monitoring Program (PMP) is a statewide electronic database containing information on dispensed Schedule II-V prescriptions, gabapentin (a drug of concern), and naloxone. The primary purpose of the PMP is to promote safe prescribing and dispensing practices for covered substances by providing timely and essential information to healthcare providers. Both the Code of Virginia (§ 54.1-25.2) and Virginia Administrative Code (18VAC76-20) contain laws and regulations applicable to the PMP.

In addition to the utility for healthcare providers, the data collected can be useful in identifying unusual patterns of prescribing and dispensing for review by the applicable regulatory board. Approximately one million prescriptions are reported to PMP monthly and developing specific, meaningful criteria to detect aberrant behavior is challenging. Consequently, investigative findings by regulatory boards and analysis methodologies are regularly reviewed and refined. The section entitled Identifying unusual patterns of prescribing and dispensing, beginning on page two, describes this process in depth.

As a result of legislation during the 2018 General Assembly session, two operational changes occurred on July 1, 2018: prescriptions dispensed for Schedule V medications and naloxone were added as covered substances and veterinarians must report covered substance dispensing for a course of treatment exceeding seven days.

Notable findings in the 2018 Annual Report (analyses based on January 2017-June 2018) Medications that are most commonly abused can be grouped into four categories: pain relievers, stimulants, tranquilizers, and sedatives. The overall quantity of pain reliever, sedative, and tranquilizer doses dispensed decreased between 16% and 31%. Stimulant doses remained stable.

Prescribing of opioids is decreasing. The number of patients receiving and practitioners prescribing opioids declined by 25% and 10%, respectively.

Regulations Governing Prescribing of Opioids and Buprenorphine (18VAC85-21), promulgated by the Board of Medicine, became effective in March 2017 and imposed limits on prescribing buprenorphine without naloxone (mono-product) for opioid use disorder due to the potential for misuse and abuse. As a result, mono-product prescriptions decreased by 52%.

Pursuant to Code of Virginia § 54.1-408.02, beginning July 1, 2020 any prescription containing an opioid must be transmitted electronically (e-prescribing) from the prescriber to the dispenser. Though increasing incrementally, in June 2018, only 12% of opioids were submitted electronically and 78% written. The remaining 10% were transmitted via fax or by telephone.

Utilization of the PMP by prescribers, pharmacists, and their delegates has increased steadily over time. Specifically, quarterly use nearly quadrupled.