Our findings suggest the need to shift the addiction treatment field from an acute care model to a chronic disease management paradigm and the need for more aggressive screening, intervention, and addiction management over time.
This research examines the effects of Prescription Drug Monitoring Programs (PDMPs) on the supply and abuse of prescription drugs. Information from the Automation of Reports and Consolidated Orders System (ARCOS) is used to develop measures of supply, and information from the Treatment Episode Data Set (TEDS) is used to develop measures of abuse. Practical considerations lead us to focus on Schedule II pain relievers and stimulants, and composite measures for these two classes of drugs are developed. We estimate both aggregate and individual response models. The aggregate model suggests that PDMPs reduce the per capita supply of prescription pain relievers and stimulants and in so doing reduce the probability of abuse for these drugs. The evidence also suggests that states which are proactive in their approach to regulation are more effective in reducing the per capita supply of prescription pain relievers and stimulants than states which are reactive in their approach to regulation. The individual response model confirms these findings. It is important to note that the probability of pain reliever abuse is actually higher in states that have PDMPs than in states that do not. But our analysis demonstrates that in the absence of such programs the probability of abuse would be higher still.
Objectives:“Doctor shopping” as a means of prescription opioid diversion is examined. The number and percentage of prescriptions and morphine-equivalent milligrams diverted in this manner are estimated by state and molecule for the period 2008-2012.Methods:Eleven billion prescriptions with unique patient, doctor, and pharmacy identifiers were used to construct diversion “events” that involved between 1 and 6 unique doctors and between 1 and 6 unique pharmacies. Diversion thresholds were established based on the probability of each contingency.Results:A geographically widespread decline occurred between 2008 and 2012. The number of prescriptions diverted fell from approximately 4.30 million (1.75% of all prescriptions) in 2008 to approximately 3.37 million (1.27% of all prescriptions) in 2012, and the number of morphine-equivalent milligrams fell from approximately 6.55 metric tons (2.95% of total metric tons) in 2008 to approximately 4.87 metric tons (2.19% of total metric tons) in 2012.Conclusions:Diversion control efforts have likely been effective. But given increases in opioid-related deaths, opioid-related drug treatment admissions, and the more specific resurgence of heroin-related events, it is clear that additional public health measures are required.
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