State prescription drug monitoring programs a window into fight against opioid abuse

Photo: ^Thais^ via Flickr

Photo: ^Thais^ via Flickr

With an estimated 78 opioid-related deaths per day nationwide, policymakers, journalists and the public are sounding the alarm on overprescribing of narcotic painkillers.

Reporters covering the opioid crisis might want to look at state efforts to track opioid prescribing by physicians. State prescription drug monitoring programs (PDMPs) are electronic databases that gather information from pharmacies on controlled substance prescriptions. PDMPs are potentially powerful disincentives for overprescribing, according to a recent study.

Implementation of a state PDMP was associated with more than a 30 percent reduction in the rate of prescribing Schedule II opioids, according to a June 2016 study in Health Affairs.

The reduction was seen immediately after 24 states implemented their PDMP, and was sustained in the programs’ second and third years of operation, according to the report led by researchers at Weill Cornell Medical College in New York. The study included 26,275 ambulatory care office visits, culled from prescription drug monitoring programs implemented between 2001 and 2010.

Why did opioid prescribing for pain drop so substantially after program implementation? The authors speculate that the programs made prescribers – mostly physicians and dentists – more aware of abuse potential just through their very existence. “It is also possible that knowing that their prescribing was being ‘watched’ deterred them from prescribing Schedule II opioids to some extent,“ the study authors wrote.

Typical users of PDMPs include law enforcement agencies, state medical boards, state insurance agencies, public health departments, physicians and pharmacists. The databases can help identify patients at high risk of ‘doctor shopping’ to obtain opioid prescriptions or ‘diversion’ (channeling drugs to others for abuse).

The Centers for Disease Control and Prevention has a guide to state PDMP successes. However, there are some issues with these programs, like that some of the data is not available in real time, and that providers don’t always check the database prior to writing a prescription.

Ideas for journalists

  • Check the status and effectiveness of your state’s PDMP. How are law enforcement, physicians and state officials using the database? What is the lag time between pharmacy reporting and the information’s availability to prescribers?
  • See if there are any looming deadlines for compliance. For instance, in California, all physicians licensed to prescribe controlled substances must be registered with the state’s PDMP by July 1, 2016.
  • Ask your state medical association and state medical board about any issues with the utility and accessibility of the database. Again in California, physician groups raised concerns about computer browser requirements to access the state’s upgraded database.
  • Watch for analysis on the impact of a PDMP. Kentucky officials found that the state’s PDMP resulted in a 50 percent reduction in the number of patients who received prescriptions from four or more prescribers and filled at four or more pharmacies within a three-month period.
  • Are physicians and health officials seeing any unintended consequences of the PDMP? These could include a “chilling effect“ on legitimate prescribing or a rise in heroin abuse as prescription opioids become less available.
  • And follow the excellent work of journalists in Missouri, who are reporting on the consequences of a lack of a state PDMP. Some examples of Missouri coverage are here, here and here.

All states except Missouri have either implemented prescription drug monitoring programs or have enacted laws to do so. The ease of use and status of these databases varies widely by state.


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