Deficiencies with the Use of Prescription Drug Monitoring Program in Cancer Pain Management: A Report of Two Cases

Abstract

Background: Prescription drug monitoring programs (PDMPs) help maintain electronic records of controlled substances and are a resource to help direct patient care. As the use of these electronic programs expands, limitations of their use are becoming more apparent. We present two cases that illustrate the effects and the need to interpret the PDMPs with caution. Cases Description: Case 1: A male in his 60s presented with metastatic lung cancer who was being managed by our team for pain management along with oncology for cancer directed care. The PDMP erroneously reported that he had filled methadone, thereby impacting the provider-patient relationship. The second case was a female patient in her 40s who had metastatic lung cancer currently receiving cancer directed therapy and also followed with the Supportive Care Clinic for the management of cancer associated pain. The patient had demonstrated nonmedical opioid use behaviors in past visits so a careful monitoring approach had been implemented by the clinic to help safely prescribe opioids. The patient was wearing a fentanyl patch that was found only on physical examination during a clinic visit, because it was not noted in the PDMP. Conclusion: The PDMP has been found to assist physicians in decision making but there are limitations with its use. Enhanced real-time reporting of opioid prescribing information, increased integration into electronic health systems, and universal interstate sharing of prescribing data are some of the ways to improve their effectiveness. More research is needed to further examine the deficiencies and improve on its utility in routine chronic opioid therapy.