Impact of a prescription drug monitoring program use mandate on potentially problematic patterns of opioid analgesic prescriptions in New York City

Abstract

Purpose To evaluate New York State's mandate that prescribers query the prescription drug monitoring program (PDMP) prior to prescribing Schedule II‐IV medications. Methods We conducted an interrupted time series analysis of opioid analgesic prescriptions dispensed to adult New York City (NYC) residents using data from New York State's PDMP. Our main outcomes were the rate of (a) greater than or equal to five prescriber episodes, (b) greater than or equal to five prescriber and greater than or equal to five pharmacy episodes, and (c) paying for prescriptions with both cash and insurance, per quarter, per 100 000 NYC residents. We defined three periods: (a) the baseline period (January 2011 to July 2012), (b) the anticipatory period (September 2012 to July 2013) after mandate law enactment but before mandate implementation, and (c) the postmandate period (September 2013 to December 2015). For each outcome, we used autoregressive linear regression models to account for correlation in outcomes over time. Results At the end of the postmandate period, the rate of greater than or equal to five prescriber episodes was 58% lower than expected (absolute difference: −17.2 per 100 000 NYC residents; 95% CI, −31.2 to −3.1), the rate of greater than or equal to five prescriber and greater than or equal to five pharmacy episodes was 88% lower than expected (absolute difference: −8.6; 95% CI, −11.0 to −6.3), and the rate of cash and insurance payment episodes was 50% lower than expected (absolute difference: −145.4; 95% CI, −279.4 to −11.6). Conclusions While outcomes were relatively rare, New York State's PDMP mandate was associated with significant decreases in rates of potentially problematic patterns of opioid analgesic prescriptions.

A Rapid Review of the Impact of Systems-Level Policies and Interventions on Population-Level Outcomes Related to the Opioid Epidemic, United States and Canada, 2014-2018

“…92,93 Six studies found that mandatory use of PDMPs, including unsolicited and proactive reporting of patient prescription histories, improved opioid-related outcomes. [94][95][96][97][98][99] ThesepositivefindingsonstrongPDMPswere notuniform:1studyfoundnosignificantassociationbetween mandatory use requirements and the number of opioid prescriptions among patients undergoing general surgical procedures 100 and another study found that strong and weak PDMPs were associated with similar changes in opioid prescription rates, the number of cumulative doses, and prescriptionlength(indays)amongMedicarebeneficiaries. 101 Studies published after our review period investigated GoodSamaritanlaws,painclinicandmarijuanaregulations, prescribing guidelines, and educational interventions.…”

Trends in Opioid Prescribing Following Statewide PDMP Implementation: The Pennsylvania Experience

“…In New York, the implementation of a PDMP (I-STOP law) saw a signi cant decrease in rates of potentially problematic patterns of opioid prescribing, 10 as well as a leveling off of prescription opioid mortality. 11 In Pittsburgh, Pennsylvania, a PDMP use mandate was associated with fewer patients prescribed opioids in the emergency department than pre-PDMP implementation.…”

Longitudinal impact of a pre‐populated default quantity on emergency department opioid prescriptions

“…Many national, state, and institutional organizations have adopted opioid prescribing guidelines, which have demonstrated significant reduction in opioid prescriptions. [14][15][16][17][18][19] Although the longterm impact of changing prescribing practices on total opioid-related deaths is still unclear, a decrease in prescription overdose death rates occurred from 2016 to 2017 in the majority of ages <65 years old with a statistically significant decrease of 13.2% in males 15-24 years old. 1 Most guidelines currently recommend non-opioid analgesics as firstline therapies and limiting any opioid prescription to a 3-day supply of the lowest effective dose of a short-acting opioid for acute pain.…”