Section 1: PMP Overview

The Oklahoma Bureau of Narcotics and Dangerous Drug Control oversees the Oklahoma PMP. It monitors the dispensation of Schedule II–V controlled medications and is an important resource for addressing the opioid epidemic in Indian Country.

The Indian Health Service (IHS) policies and individual state laws related to PMPs provide ways to assess best practices. Pharmacists have two important roles regarding the PMP:

1. Pharmacists, or their designated delegates, should check the PMP before dispensing Schedule II–V controlled medications. The designated delegates should have their own PMP accounts registered under the dispenser. According to IHS (2020) policy, the pharmacist should check the PMP before: a. Dispensing an outside prescription for a controlled substance b. At least every 3 months before reissuing or refilling for a chronic controlled substance prescription for Schedule II–V controlled medications for existing patients.

2. Pharmacists, or their designated delegates (with their own PMP system logins), should record the dispensation of Schedule II–IV controlled medications. Oklahoma law states that this should be done within 5 min of dispensation (Oklahoma Bureau of Narcotics and Dangerous Drug Control, 2020). IHS (2020) states that dispensing data should be reported at the frequency requested by the state.

A POCKET BOOK GUIDE FOR PHARMACISTS

2 Detecting Potential Prescription Concerns

With the PMP

Section 2: Detecting Potential Prescription Concerns With the PMP

For pharmacists, checking the PMP can help note concerns such as:

• early refills

• multiple providers

• multiple pharmacies

• multiple prescriptions

• altered prescriptions

• an extended duration (i.e., over 7 days) opioid prescription for acute pain

• dangerous medication combinations (e.g., overlapping benzodiazepine and opioid prescriptions)

Identifying these factors can help enhance patient safety and lead to better health outcomes. (CDC, n.d., 2021). The Resources section contains links to more information about chronic pain management, safer opioid prescribing, and substance use disorders.

A POCKET BOOK GUIDE FOR PHARMACISTS

3 Detecting Potential Prescription Concerns

With the PMP

Section 3: Addressing Concerns About the PMP Report With Patients

If a patient’s PMP report is concerning to the pharmacist and/ or their designated delegate, the pharmacist should do the following:

• discuss it with the prescriber to address concerns,

• discuss their concerns directly with the patient, and ultimately,

• decide whether to fill and dispense the medication (Resources Encouraging Safe Prescription Opioid & Naloxone Dispensing [RESPOND], n.d.).

Talking To Patients About The Pmp

Talking to patients about their PMP report, your concerns, and your clinical decision related to their prescription can be difficult, There are five main considerations to keep in mind when discussing your concerns with a patient:

1. Introduce yourself to the patient.

2. Let the patient know you have reviewed their PMP report and prescription history. Some patients may not know what the PMP is, and they may be surprised when it is mentioned.

3. Center the conversation around the patient’s safety and health.

4. Be respectful by using nonjudgmental and supportive language.

5. Inform the patient of your next steps and predicted timeline (RESPOND, n.d.).

When having these difficult conversations, remember to:

• Allow plenty of time to discuss concerns with the patient.

• Patients may be able to communicate their situations more effectively through storytelling.

• Remember that the patient may be in physical, spiritual, or mental pain (Jimenez et al., 2011)

• Ask open-ended questions to help build trust and collaboration.

• Use active listening techniques. Let the patient know they are being heard.

• Thank the patient for sharing their experiences.

• If met with anger or hostility, recenter the conversation on patient safety.

• Focus on the facts.

Follow this example: “Having multiple opioid prescriptions means that you are at a higher risk of overdose. My priority is your wellbeing and safety” (RESPOND, n.d.).

If possible, try to end the conversation with positive language (RESPOND, n.d.). See the following pages for examples.

FOUR STEPS TO TAKE WHEN DISCUSSING A PATIENT’S PMP AND DISPENSING DECISIONS

1. Introduce and inform

◦ “Hi, my name is Kasey, and I am a pharmacist here. It’s nice to see you. I have checked your prescription history using the Prescription Monitoring Program, or the PMP. Have you heard of the PMP?”

◦ Tip: Start building a foundation of support here (example: “It seems like you haven’t heard about the PMP. This is common. Would you like more information about it?”).

2. Be respectful and safety-centered

◦ “I am concerned that a couple of your prescriptions could be harmful when taken together. Are you having difficulty treating your pain?”

3. Allow time for discussion

◦ “Thank you for sharing. It sounds like you’ve had a difficult time finding a treatment for your pain. What concerns do you have about adding (more) pain pills to your current medications/ treatment strategies?”

◦ Tip: Use active listening here. Try phrases such as “It sounds like . . .” or “I get the sense that . . .”

4. Affirmation and next steps

◦ “The fact that you have those concerns really shows that you are committed to your health. We’re going to hold off on filling your prescription at this time. I am going to talk to your provider today to recommend they review your prescription history and consider an alternative way to manage your pain.”

Note. Adapted from “Pharmacy PDMP Toolkit,” by Resources Encouraging Safe Prescription Opioid & Naloxone Dispensing, n.d., PowerPoint slides.