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Legislative auditors slam prescription drug monitoring program

State House Bureau

December 15. 2017 12:09AM

CONCORD — The state’s Prescription Drug Monitoring Program, established in 2012 to help reduce prescription drug abuse, has been plagued by “inadequate planning and implementation,” according to a performance audit by the Office of Legislative Budget Assistant.

The audit is scheduled for review by the Joint Fiscal Committee today. It was requested by the Legislature to determine the effectiveness of the program in reducing the over-prescribing of drugs such as opiate-based painkillers, which have been cited as a major cause of the addiction crisis of the past five years.

The program, in operation since 2014, has suffered from a lack of direction and follow-through, according to the audit.

Doctors have been providing the prescription data. But the audit suggests very little has been done with it to inform policymakers on the role of prescribing practices in the crisis that this year will claim more than 450 lives in the Granite State.

After three years of operation, the program is still “at an initial stage of maturity,” according to the executive summary of the 146-page report.

Other key findings:

• The state Pharmacy Board, charged with implementing the PDMP, lacks a strategy to achieve the objectives set out for the program.

• The 14-member Controlled Drug Prescription Health and Safety Program Advisory Council, created by legislation to assist the board with implementing and operating the PDMP, never developed the criteria necessary for the program to succeed, including “criteria for reviewing PDMP data, reporting matters for further investigation and notifying practitioners of concerns.”

• The council never collected data on user satisfaction, impact on prescribing patterns, impact of referrals or “other relevant measures of PDMP outcomes and impact.”

• The correct number of practitioners required to register with the PDMP was never established.

• There is no indication that the Pharmacy Board, its staff or the Advisory Council ever attempted to measure compliance or enforce reporting requirements “holistically” across the spectrum of practitioners statewide.

The Audit Division within the Office of Legislative Budget Assistant is staffed by professionals in performance evaluation, and is regularly called upon by the Legislature to assess the effectiveness of state programs and institutions. Its most recent publicly released audit was on the Community College System of New Hampshire.

The audit of the prescription drug program is scheduled for public release after it is formally accepted by the Fiscal Committee, but the Union Leader obtained an advance copy.

The audits are designed to point out flaws, not issue commendations, so they are by nature critical, but the PDMP audit contains some particularly harsh language.

“The systems and subsystems necessary for effective operations were either mis-oriented, poorly structured or altogether absent, and significant management controls were not implemented,” they write. “The PDMP was implemented without relevant data collection, reporting mechanisms and cycles, or formats necessary to effectively communicate its operation and performance internally and externally.”

The audit reports that the implementation and operation of the PDMP has been inhibited by “staffing turnover, organizational turbulence, frequent changes in underlying law and funding constraints,” and goes on to point out that the PDMP data collected for the past three years has “essentially gone unanalyzed and has not been systematically used to create knowledge of PDMP outcomes and effectiveness.”

Seven pages of recommendations include such things as formally establishing a way to identify “doctor shopping” in the PDMP data, which many lawmakers thought was one of the main objectives of the program in the first place.

The Board of Pharmacy agrees with most of the findings in the audit, and outlines steps it plans to take in response. One point of contention is law enforcement access, which the audit suggests should be enhanced to meet legislative expectations.

“Any issues with increasing integration of law enforcement with the PDMP program have been well documented in past legislative discussions and will need to be addressed at that level,” according to the board’s response. “The board does not agree that it is responsible for increasing law enforcement access.”

New Hampshire became the 49th state to establish a state-run PDMP in 2012 and in 2013 received a $400,000 federal grant to launch the program. Practitioners were required to be registered no later than June 30, 2015.

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