RD531 - Virginia Prescription Monitoring Program 2020 Annual Report – November 1, 2020

Executive Summary:

The Virginia Prescription Monitoring Program (PMP) is a statewide electronic database containing information on dispensed Schedule II-V prescriptions, naloxone, and cannabis oils dispensed from an in state pharmaceutical processor. 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 (§ 54.1-2519 et seq.) 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. Notably, 13% of cases initiated through this process have been found in a violation; by comparison, only 8% of complaint-driven cases involving patient care were found in violation. The section entitled Identifying unusual patterns of prescribing and dispensing, beginning on page 7, describes this process and case findings in depth.

The disruption to the healthcare system due to Covid-19 also impacted observed trends in dispensations reported and PMP use. Notably, opioid prescriptions declined by 13% between 2020Q1 and 2020Q2. Further, following continuous increases over the last several years, quarterly requests declined for the first time in 2020Q2.

Notable findings in the 2020 Annual Report

Prescribing of opioids is decreasing with the greatest decrease—56%—in very high-dose prescriptions. Specifically, prescriptions for daily dosages of 120 morphine milligram equivalents or greater decreased from 5.7 to 2.5 per 100 Virginians (2015 to 2019).

Regulations Governing Prescribing of Opioids and Buprenorphine (18VAC85-21-10), 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. Since that time there was an overall decline of 66% in mono-product buprenorphine prescriptions.

Pursuant to Code of Virginia § 54.1-3408.02, any prescription containing an opioid must be transmitted electronically (e-prescribed) from the prescriber to the dispenser as of July 1, 2020. Approaching the new law’s effective date, there was a dramatic increase in opioid e-prescribing from 18% in January 2019 to 52% in June.