Study: Prescription drug monitoring programs lead to less opioid prescribing

In 2014, more than 28,000 people in the U.S. died from an opioid overdose. That same year, more Americans died from drug overdoses than during any other year on record, with the escalating numbers fueled by opioid abuse. Solutions to the problem are as complex as the epidemic itself, however a recent study pointed to one tool that can make a significant difference: prescription drug monitoring programs.

In a study published this month in Health Affairs, researchers found that implementation of a prescription drug monitoring program was linked to a more than 30 percent reduction in the rate of prescribing schedule II opioids, which is the category with the highest risk of abuse and dependence. Such monitoring programs have been around for quite some time, but a new round of such systems began in the early 2000s. Today, according to the study, every state except Missouri has moved to either implement or upgrade their monitoring systems or have adopted legislation that authorize such actions. Electronic prescription drug monitoring programs allow prescribers to view a patient’s prescription drug history with a goal of preventing doctor shopping and drug diversion.

Study co-authors Yuhua Bao, Yijun Pan, Aryn Taylor, Sharmini Radakrishnan, Feijun Luo, Harold Alan Pincus and Bruce Schackman write:

More than ten million Americans reported using opioids nonmedically in 2014. Nonmedical users may obtain controlled substances by getting multiple prescriptions from multiple prescribers, a behavior known as “doctor shopping,” or from friends or relatives for whom the substances were prescribed, a practice known as “diversion.” Prescribers — generally primary care physicians and dentists, as opposed to pain medicine specialists — are thus an important link in helping address this deadly drug overdose epidemic. Information on potential misuse and abuse of prescription opioids can help these prescribers strike a balance between alleviating pain for patients and ensuring safe prescribing.

To conduct the study, researchers analyzed data from the National Ambulatory Medical Care Survey from 2001 to 2010, zeroing in on patients who reported pain as one of the reasons for their doctor visits. Ultimately, the dataset included more than 26,000 pain-related outpatient care visits in 24 states that had implemented a drug monitoring program sometime between 2001 and 2010. Overall, they found that 5 percent of visits resulted in at least one schedule II opioid prescription, 15 percent resulted in at least one opioid painkiller prescription, 41 percent resulted in the prescription of a pain medication, and 24 percent ended with a non-opioid painkiller prescription. However, the advent of a prescription drug monitoring program significantly slowed such prescribing trends.

Researchers reported that such systems were associated with a reduction in the prescribing of both schedule II opioids and opioids of any kind, as well as less prescribing of pain medications overall. In fact, such systems were associated with a slight increase in the prescribing of non-opioid painkillers. During the study period, the probability of receiving a schedule II opioid prescription during an office visit dropped from 5.5 percent to 3.7 percent, which marks a more than 30 percent reduction from the time period before the monitoring programs were in place.

As for a longer-term effect, the study found a 2.1 percentage point reduction in schedule II opioid prescribing in the first six months of a prescription drug monitoring program being implemented; a 2.2 percentage point reduction in months seven through 12; and a 1.8 percentage point reduction in months 19 through 24. Overall, researchers found that such monitoring programs had a sizeable impact on schedule II opioids, but a limited impact on other kinds of opioids and pain medications in general.

But even though the prescribing tool shows promise in helping to confront the opioid crisis, the study noted that prescriber awareness and participation is pretty low. It cited a report from the Prescription Drug Monitoring Program Center of Excellence at Brandeis that found a median drug monitoring program registration rate of just 35 percent among those who had prescribed at least one controlled substance from 2010 to 2012.

“As prescription drug monitoring program policymaking has shifted from implementation to enhancement, future research is needed to evaluate the comparative effectiveness of key policies and practices designed to promote the reach and effectiveness of these programs,” the study stated.

To request a full copy of the study, visit Health Affairs.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for nearly 15 years.

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Great article. I must say, I read a lot of these blogs, but I am rarely as interested as I was when reading this one. Great work.