Effects of Implementation and Enforcement Differences in Prescription Drug Monitoring Programs in 3 States: Connecticut, Kentucky, and Wisconsin

Abstract

Background and aims: Prescription Drug Monitoring Programs (PDMPs) were designed to curb opioid misuse and diversion by tracking scheduled medications prescribed by medical providers and dispensed by pharmacies. The effects of PDMPs on opioid prescription, misuse and overdose rates have been mixed due in part to variability in states’ PDMPs and difficulties measuring this complexity, and a lack of attention to implementation and enforcement of PDMP components. The current study uses qualitative interviews with key informants from 3 states with different PDMPs, Connecticut, Kentucky and Wisconsin to explore differences in the characteristics of the PDMPs in each state; how they are implemented, monitored and enforced; and unintended negative consequences of these programs. Methods: We conducted in-depth interviews with key informants from each state representing the following sectors: PDMP and pain clinic regulation agencies, Medicaid programs, state licensing boards, pharmacies, emergency medicine departments, pain management clinics, first responders, drug courts, drug treatment programs, medication assisted treatment (MAT) providers, and harm reduction organizations. Interview guides explored participants’ experiences with and opinions of PDMPs according to their roles. Data analysis was conducted using a collaborative, constant comparison method. Results: While all 3 states had mandated registration and reporting requirements, the states differed in the implementation and enforcement of these and the extent to which provider prescribing was monitored. These, in turn, influenced how medical providers perceived the PDMP and changed how providers prescribed opioids. Unintended consequences of state PDMPs included under-prescribing for pain and “dumping” patients who were long term users of opioids or who had developed opioid use disorders and may explain the increase in illicit heroin or opioid use. Conclusion: State PDMPs with similar mandates may differ greatly in implementation and enforcement. These differences are important to consider when determining the effects of PDMPs on opioid misuse and overdose.

“The DEA Would Come In And Destroy You”: A Qualitative Study of Fear And Unintended Consequences Emerging From Restrictive Opioid Prescribing Policies In West Virginia

“…On an economic level, some researchers estimate that undertreatment of pain may lead to loss of productivity costing the United Sates as much as 299 billion dollars annually [44]. Our participants related care gaps and forced tapering as a result of SB 273, similar to that reported by Dickson-Gomez and colleagues as unintended consequences of PDMP implementation in various states [45]. The idea that such supply-side restrictions on prescribed opioids may drive illicit use and opioid related deaths has also been explored and supported in a further quantitative analysis by Kim [46].…”

Evaluating State-Level Prescription Drug Monitoring Program (PDMP) and Pill Mill Effects on Opioid Consumption in Pharmaceutical Supply Chain

“…Research on the effectiveness of PDMP and Pill Mill laws has produced mixed results, with some studies finding that these laws are associated with reduced opioid prescribing and overdose deaths, while others have found no significant impact [21,22]. Some factors that may influence the effectiveness of these laws include the degree to which they are integrated into clinical practice, the extent to which they are used by prescribers and dispensers, and the level of support and training provided to those who use the system.…”

The effects of opioid policy changes on transitions from prescription opioids to heroin, fentanyl and injection drug use: a qualitative analysis

“…PDMPs have also changed over time, often moving from more voluntary to mandatory use [62]. Interviews with people in charge of developing and implementing the PDMP in each of our study states talked about changes over time moving from encouraging physicians and prescribers to register with the PDMP to mandatory checking of the PDMP when prescribing or dispensing any opioid [63]. PWUO reported changes in physicians' prescribing practices that occurred gradually over time, centering around the time PO restriction policies were initiated.…”