Texas: Creating the Nation’s Model Prescription Monitoring Program

The Texas Orthopaedic Association (TOA) is urging members to write to their state lawmaker to ensure that the Texas Legislature provides funds for the Texas State Board of Pharmacy (TSBP) to acquire the NarxCare license for Texas physicians to meet the state’s September 1, 2019 mandate to check the prescription monitoring program (PMP) database. Below is a widget to contact your state lawmaker. Due to the mandate’s upcoming deadline, it is critical for the Legislature to secure funding in the supplemental package.

The state’s PMP collects a patient’s controlled substances prescription drug history, which allows pharmacists and physicians to review a patient’s prescription drug history. This mandate served as the centerpiece of the 2017 Legislature’s effort to address “doctor shopping.”

Orthopaedic surgeons view the PMP as a helpful clinical tool that could limit some misuse and diversion. However, the PMP, in its current state, requires physicians to manually log into the program, which takes valuable time away from patient care. Fortunately, Texas has the ability to follow the lead of many other states by purchasing the NarxCare license for all physicians to whom the mandate applies (Texas State Board of Pharmacy for Statewide Integration Purchase & Enterprise NarxCare & Clinical Alerts). This technology adds a tool to a physician’s electronic health record program that allows a physician to simply click a button in the patient’s electronic file that seamlessly directs the patient’s file to a view of the patient’s PMP history, which satisfies the mandate.

The Texas Legislature is likely to continue the discussion about opioids again in 2019. TOA strongly urge members to read the Texas Orthopaedic Association’s white paper on the issue, which provides helpful background on opioids. Click here to view the paper.

When policymakers make policy decisions related to opioids, care must be taken to limit unintended and undesirable consequences. Unfortunately, the current nationwide shortage of parenteral (intravenous) opioids can be traced to past responses to the opioid crisis. It is important to keep in mind that high-energy injuries, such as pelvic and femur fractures, and certain musculoskeletal surgeries, such as spinal fusion for adolescent scoliosis, create tremendous pain that may require an opioid response. It is critical to not enact policies that would have the unintended consequence of preventing patients who have suffered high-energy injuries or who are undergoing major surgeries from having access to adequate pain control mechanisms. With that said, the Texas Orthopaedic Association (TOA) recognizes that opioids are part of our nation’s overall drug misuse and abuse epidemic, and it is critical for orthopaedic surgeons to identify ways for physicians to be a part of the strategy to decrease opioid use, misuse, and abuse.

Per the American Academy of Orthopaedic Surgeons (AAOS):

The AAOS believes that a comprehensive opioid program is necessary to decrease opioid use, misuse, and abuse in the United States. New, effective education programs for physicians, caregivers, and patients; improvements in physician monitoring of opioid prescription use; increased research funding for effective alternative pain management and coping strategies; and support for more effective opioid abuse treatment programs are needed.

Click here to read the TOA White paper on this issue.