Are State Controlled Substance Monitoring Systems Linked?

RobMac asked

My brother is a "know it all" and I do not believe what he has told me. According to him, a person can fill a prescription like hydrocodone in one state and then again in another state a week or two later for the same medication (new prescription written by a Dr in the state). I say they cannot get a new prescription filled in a different state because of PMP laws and states share this info. My brother says if one pays cash there is no prescription trail. Please give your expert take on this.

Answer

All states (except for Missouri) have prescription drug monitoring programs that track an individual's controlled substance fill history.

These monitoring programs are often referred to as 'Prescription Monitoring Programs' (PMP) or 'Prescription Drug Monitoring Programs' (PDMP).

The purpose of these programs are to allow designated individuals to search for and access the controlled substance fill history for a particular patient, with the goal being to reduce drug abuse and diversion.

An important point about these programs is that they are run by individual States, NOT the DEA. Direct from the FAQ section of the DEA website:

"The DEA is not involved with the administration of any state PDMP."

The rules of each individual program, and the data that is collected, is not universal. Variations among the programs include:

• Origin of prescription (e.g. inpatient, outpatients) that must be recorded.
• Quantity limit of controlled substance to be recorded.
• Mechanisms for reporting and accessing data.
• Minimum day supply dispensed that must be recorded.
• Frequency of data upload to the program.
• Who can access the data.
• Schedule of drug that must be recorded.

Prescription Monitoring Programs By State

With the exception of Missouri, every state (and the District of Columbia) have a prescription drug monitoring program, which are detailed in the chart below.

Interstate Sharing

Although every state administers and maintains their respective prescription drug monitoring program, over 45 participate (or are scheduled to participate) in interstate sharing of data. They are:

• Alaska
• Alabama
• Arizona
• Arkansas
• Colorado
• Connecticut
• Delaware
• District of Columbia
• Georgia
• Idaho
• Illinois
• Indiana
• Iowa
• Kansas
• Kentucky
• Louisiana
• Maine
• Maryland
• Massachusetts
• Michigan
• Minnesota
• Montana
• Mississippi
• Nevada
• New Jersey
• New Hampshire
• New Mexico
• New York
• North Carolina
• North Dakota
• Ohio
• Oklahoma
• Oregon
• Pennsylvania
• Rhode
• Island
• South Carolina
• South Dakota
• Tennessee
• Texas
• Utah
• Vermont
• Virginia
• West Virginia
• Wisconsin

Interstate sharing of prescription monitoring program data is facilitated by 'NABP PMP InterConnect', which is described as:

"The benefits of state PMPs are enhanced by PMP InterConnect because the system provides the means for physicians and pharmacists to more easily identify patients with prescription drug abuse and misuse problems, especially if those patients are crossing state lines to obtain drugs. Utilizing the program’s connected web of information allows appropriate intervention and aid in the prevention of substance abuse and diversion of controlled substances."

Below is a map showing all InterConnect participants:

The sharing of prescription drug program data between states is still relatively new, as InterConnect was only introduced in 2011.

Each state varies in regard to who can access out-of-state data, and how accessible it is (i.e. permission for an individual to access another state’s data varies between states.)

Some states, like New York, allow users of the PMP to easily search the fill history of an individual in New York and many of the participating InterConnect states. Other states may require a specific request that takes additional time to complete.

Nevertheless, if your state participates with InterConnect, fill history can be accessed out-of-state in one way or another.

Final Words

Most states participate in the 'interstate' sharing of prescription drug monitoring program data. Whether or not this data is readily accessible depends on the state in question as each individual state has its own rules concerning who may search its registry and what data it provides.

To touch on the situation you described, paying 'cash' in two different states (resulting in no prescription trail), was at one point true but is no longer the case in most situations.

Historically, it was an individual's insurance company that would 'flag' a pharmacy/pharmacist regarding a similar/same drug fill, regardless of filling location.

If you got your prescription without involving your insurance, it would be very difficult for a pharmacist or law enforcement to track it.

However, with the advent of prescription monitoring programs (PMPs) and the sharing of prescription fill data, it is much easier for a health care professional to have a complete fill history for a patient.

In fact, some states require a health care professional check their respective states PMP prior to writing (or dispensing) a controlled substance prescription.

Although the recording and sharing of data has come a long way, there may be a particular situation where the data between two states isn't linked... for now. Moving forward, this will be become more and more uncommon.