Staff Report with Final Results: Texas State Board of Pharmacy Page: 11
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Sunset Advisory Commission June 2017
Texas' Prescription Monitoring Program lacks key best
practices needed for the state to understand and respond to
prescription drug abuse.
A strong prescription monitoring program is a clear best practice for states,
but Texas has lagged behind in recent years. Forty-nine states have programs
similar to Texas, and these systems have become powerful tools for prescribers,
pharmacists, and regulatory agencies to understand trends and identify problem
areas within their communities. While Texas was initially in the vanguard
when it created a statewide database in 1982, its placement at the Department
of Public Safety focused its use for law enforcement purposes, and features
to help prescribers and dispensers use the information never fully developed.
These and other concerns about the system's usability for public health purposes
prompted the Legislature's decision to transfer the program to the Pharmacy
Board in 2015.17
The Prescription Drug Monitoring Program Center of Excellence at Brandeis
University identifies best practices and provides analysis to assist states in
maximizing these programs, drawing on the expertise of national specialists
in addiction, pain treatment, and public health. In 2012, the Center published
an assessment of best practices, identifying specific areas where states often
underutilize their programs.18 These best practices aim to identify potential
drug abuse, but not preemptively limit patient access to needed medication.
While the board plans to make improvements to the program when it transfers,
some improvements require changes in law to fully implement. Sunset staff
compared Texas' current program operated by the Department of Public Safety
with national best practices, and identified the following gaps where the current
system fails to meet best practices.
" Unacceptably low use by pharmacists. By creating prescription drug
monitoring programs, states have decided tracking controlled substances
is an important public safety measure and have invested millions of dollars
in these databases. However, pharmacists' efforts to gather the data are
somewhat in vain if pharmacists do not check the information to inform
dispensing decisions. The Center of Excellence emphasizes increasing
the use of the database as an important best practice since this simple
step can help determine whether dispensing certain drugs could cause a
patient harm. Increased use can be achieved through voluntary efforts
such as promotional campaigns, user education, and making the system
easy to access, or by simply requiring users to look at the system before
dispensing certain drugs.
Texas' voluntary approach for pharmacist use of the system has not worked
well, representing a major lost opportunity to enhance patient safety and
protect public health. The textbox on the following page, Texas Pharmacist
Usage of the Prescription Monitoring Program, shows the low usage rate of
the program. In fiscal year 2015, at least 74 percent of pharmacists did not
use the system at all, and 98 percent of controlled substance prescriptions
were dispensed without being checked in the database. As a result, tensConcerns about
the system's
usability for
public health
purposes
prompted the
Legislature's
decision to
transfer the
program to the
board in 2015.98 percent
of controlled
substance
prescriptions
were dispensed
without being
checked in the
database in fiscal
year 2015.Texas State Board of Pharmacy Staff Report with Final Results
Issue 111
Sunset Advisory Commission
June 2017
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Ogle, Steven; Schiff, Tamara; Hartley, Cee & Teleki, Katharine. Staff Report with Final Results: Texas State Board of Pharmacy, report, June 2017; Austin, Texas. (https://texashistory.unt.edu/ark:/67531/metapth1033475/m1/35/?rotate=0: accessed July 18, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu.; crediting UNT Libraries Government Documents Department.