×
rThe simple answer is that the stakeholders most impacted by this issue, such as the doctors and patients, want to make sure we get it right from the very beginning!
Senate Bill 883 passed this session, making Maryland the 44th state to have a Prescription Drug Monitoring Program (PDMP). As described in a fact sheet released by the Dept. of Health and Mental Hygiene (DHMH), the program would monitor the prescribing and dispensing of controlled dangerous substances (CDS), including requiring authorized dispensers (doctors, pharmacists etc) to report information to DHMH for each CDS dispensed pursuant to a prescription. It sounds simple enough, right? But then I start to wonder about the physicians I have interacted with over the years and question what exactly does reporting to DHMH mean – and more importantly, how safe is that information even when access to such databases is limited to “a defined group of persons and organizations responsible for ensuring the health and welfare of patients and the proper and lawful use of prescription drugs”. (See DHMH Fact Sheet for full summary.)
SB 883 actually is not the first attempt to implement such a program in Maryland. Legislation was passed by the General Assembly in 2006, but then vetoed by the Governor. Another bill was introduced last session but did not see any action. Why didn’t these bills succeed? Part of it was connected to fiscal concerns, which now are addressed by pending federal funding. But the greater concern - and the reason why I believed the 2006 bill to be passed prematurely - was the fact that the bills were very law enforcement focused. The physicians that I worked with over the years have never been against a PDMP in Maryland, but just as they put the health of their patients as priority, they also want to protect their patients’ privacy – privacy which is essential when building that trust to provide each patient with the best care possible.
Did “our side” get everything we wanted this go around? Of course not – but as we know that never happens with any piece of legislation. The biggest item denied in the legislation was how someone can access the data. The DHMH fact sheet highlights that the new legislation requires the “issuance of a subpoena, for the purpose of furthering an existing bona fide individual investigation.” However, they failed to share that it is an administrative subpoena and not a court ordered subpoena – which basically means whoever requests access to the records just needs a single person, such as the director of the Board of Physicians, to sign off - instead of going through the legitimate judicial process. Do we really want someone with no specific investigation at hand just phishing around through private data? On the positive side, while the current bill may not be as balanced as desired, I do think we all did our best to getting to this point and that other desired safeguards have been established to see if the program will work. This includes having a technical advisory board, which allows all stakeholders (including doctors and pain patients) to bring a balanced voice in the development, implementation, and evaluation of the PDMP. There also will be a study in the first two years to examine the program – and with the law having a “sunset” of five years, everyone will have to come back together to pass new legislation to keep the PDMP going.
There is no way to know who will still be involved in 2016, as members of the General Assembly change and leadership shifts among the different stakeholders. What I do know is the work is not done as we see what happens over the next five years and find opportunities to advocate for additional safeguards once we know what worked and what did not.
Resources: r
Senate Bill 883 passed this session, making Maryland the 44th state to have a Prescription Drug Monitoring Program (PDMP). As described in a fact sheet released by the Dept. of Health and Mental Hygiene (DHMH), the program would monitor the prescribing and dispensing of controlled dangerous substances (CDS), including requiring authorized dispensers (doctors, pharmacists etc) to report information to DHMH for each CDS dispensed pursuant to a prescription. It sounds simple enough, right? But then I start to wonder about the physicians I have interacted with over the years and question what exactly does reporting to DHMH mean – and more importantly, how safe is that information even when access to such databases is limited to “a defined group of persons and organizations responsible for ensuring the health and welfare of patients and the proper and lawful use of prescription drugs”. (See DHMH Fact Sheet for full summary.)
SB 883 actually is not the first attempt to implement such a program in Maryland. Legislation was passed by the General Assembly in 2006, but then vetoed by the Governor. Another bill was introduced last session but did not see any action. Why didn’t these bills succeed? Part of it was connected to fiscal concerns, which now are addressed by pending federal funding. But the greater concern - and the reason why I believed the 2006 bill to be passed prematurely - was the fact that the bills were very law enforcement focused. The physicians that I worked with over the years have never been against a PDMP in Maryland, but just as they put the health of their patients as priority, they also want to protect their patients’ privacy – privacy which is essential when building that trust to provide each patient with the best care possible.
Did “our side” get everything we wanted this go around? Of course not – but as we know that never happens with any piece of legislation. The biggest item denied in the legislation was how someone can access the data. The DHMH fact sheet highlights that the new legislation requires the “issuance of a subpoena, for the purpose of furthering an existing bona fide individual investigation.” However, they failed to share that it is an administrative subpoena and not a court ordered subpoena – which basically means whoever requests access to the records just needs a single person, such as the director of the Board of Physicians, to sign off - instead of going through the legitimate judicial process. Do we really want someone with no specific investigation at hand just phishing around through private data? On the positive side, while the current bill may not be as balanced as desired, I do think we all did our best to getting to this point and that other desired safeguards have been established to see if the program will work. This includes having a technical advisory board, which allows all stakeholders (including doctors and pain patients) to bring a balanced voice in the development, implementation, and evaluation of the PDMP. There also will be a study in the first two years to examine the program – and with the law having a “sunset” of five years, everyone will have to come back together to pass new legislation to keep the PDMP going.
There is no way to know who will still be involved in 2016, as members of the General Assembly change and leadership shifts among the different stakeholders. What I do know is the work is not done as we see what happens over the next five years and find opportunities to advocate for additional safeguards once we know what worked and what did not.
Resources: r
r
- r
- Senate Bill 883 r
- Testimony on Senate Bill 883 (Finance Committee – March 17, 2011 Session #2) r
- Data Update - Prescription Drug Abuse in MD (DHMH) r
- PDMP Fact Sheet (DHMH) r
- Advisory Council on Prescription Drug Monitoring Legislative Report (December 2009) r
