Prescription Monitoring Programs in Canada: Best practice and program review

Prescription psychotropic medications are important therapeutic options in clinical practice and can bring significant improvements to the quality of life of patients. However, some of these medications also have the potential to cause significant harms. The involvement of the healthcare system in both contributing to and helping to solve the problem makes this very different from the issues with other substances of abuse. In 2013, a pan-Canadian strategy called First Do No Harm: Responding to Canada’s Prescription Drug Crisis was launched. The 10-year strategy focuses on opioids, sedative – hypnotics and stimulants and includes 58 recommendations across a number of domains (CCSA 2013). The use of prescription monitoring programs (PMPs) is endorsed as one important component of the overall strategy.

The purposes of PMPs have been articulated in many ways, but the common themes are:

• To enhance patient care and assist in the safe use of controlled prescription drugs by monitoring outpatient prescription dispensing information;
• To help reduce the harms resulting from the use of controlled prescription drugs
• To assist in reducing the diversion of controlled prescription drugs.

The objectives of this review are: 1) to outline the diversity of current practices in PMPs, 2) to examine the evidence for effectiveness of PMPs, and 3) to identify which best practices out of those previously proposed in the literature, have the most supporting evidence at this point in time. PMPs cover a range of features and practices. Different PMPs may vary in models of administrative oversight, specific drugs targeted for monitoring, methods of data collection, types of interventions, and level of information sharing. There is limited supporting research evidence for many aspects of PMPs at this time; however, the volume of research reports is increasing each year, providing a growing evidence base in this area. Although established and accepted best practice recommendations do not currently exist, the following recommendations encompass practices which are supported by considerable and consistent evidence based on the findings of this review.

Best Practice Recommendations

1. Ensure unique identifiers are collected to link patient, prescriber and pharmacist records.
2. Include all prescription drugs that have been, or could be, associated with misuse and addiction.
3. Make up-to-date, full patient profiles available, confidentially, in real time to clinicians at
   point of care.
4. Send proactive, unsolicited reports to stakeholders.
5. Standardize data collection methods to optimize sharing across jurisdictions and analyze
   trends.
6. Incorporate robust safeguards to protect patient privacy.
7. Evaluate the impact of the program to detect both intended and unintended consequences.
8. Make available encrypted information in PMPs to public or private entities for statistical, research or educational purposes.