Implementation Of Prescription Drug Monitoring Programs Associated With Reductions In Opioid-Related Death Rates

Abstract

Over the past two decades the number of opioid pain relievers sold in the United States rose dramatically. This rise in sales was accompanied by an increase in opioid-related overdose deaths. In response, forty-nine states (all but Missouri) created prescription drug monitoring programs to detect high-risk prescribing and patient behaviors. Our objectives were to determine whether the implementation or particular characteristics of the programs were effective in reducing opioid-related overdose deaths. In adjusted analyses we found that a state’s implementation of a program was associated with an average reduction of 1.12 opioid-related overdose deaths per 100,000 population in the year after implementation. Additionally, states whose programs had robust characteristics—including monitoring greater numbers of drugs with abuse potential and updating their data at least weekly—had greater reductions in deaths, compared to states whose programs did not have these characteristics. We estimate that if Missouri adopted a prescription drug monitoring program and other states enhanced their programs with robust features, there would be more than 600 fewer overdose deaths nationwide in 2016, preventing approximately two deaths each day.

Examining Fatal Opioid Overdoses in Marion County, Indiana

“…Yet, in spite of these limitations, this study offers important insight into opioid overdoses. Specifically, our findings are consistent with a growing body of research suggesting that while increased regulation of prescription opiates can reduce the likelihood of these substances to be present in overdoses, [29][30][31] it also results in nonmedical prescription opiate users-those using prescription opiates, without a prescription, for the purposes of experiencing or feeling the effects of the drug-turning to illicit opioids. [32][33][34][35] …”

Commentary on Pardo (2017) and Moyo et al. (2017): Much still unknown about prescription drug monitoring programs

“…No association was found between OA deaths and PDMPs that ranked in the lower half of PDMP strength [2]. Patrick et al [10] found PDMPs to be associated with a reduction of 1.12 OA-related deaths per 100 000 population, or approximately 3000 per year. However, this reduction dropped to 0.18 OA-related deaths per 100 000 and was not statistically significant when West Virginia was excluded from the analysis [10].…”

“…Patrick et al [10] found PDMPs to be associated with a reduction of 1.12 OA-related deaths per 100 000 population, or approximately 3000 per year. However, this reduction dropped to 0.18 OA-related deaths per 100 000 and was not statistically significant when West Virginia was excluded from the analysis [10]. Both recent analyses were limited to OA-related death.…”

“…In fact, Pardo found no independent association between mandatory PDMP access requirements and reductions in OA-related deaths. Similarly, Patrick et al found that neither mandatory registration nor mandatory use of a state PDMP were associated significantly with reductions in OA-related mortality [10]. Perhaps the most dramatic refutation of this theory comes from Florida, where researchers reported a large and immediate decrease in oxycodone-related mortality after that state's PDMP came into effect-despite the fact that approximately 95% of Florida prescribers were not even registered to use it [12].…”

Funding Considerations in the Fight Against the Opioid Epidemic: What the Science Tells Us

“…For example, many early states did not require real-time updates or reporting of the system, making the timely dissemination of information or utility for identifying physician and pharmacy shopping limited. 25 Similarly, states tend not to require PDMP participation; as of May 2016, only 29 states require prescribers to register. 26 Moreover, only 34 of the states with PDMPs mandate their use by prescribers or dispensers who are registered in the state.…”