Opioid prescribing and prescription monitoring program use after buprenorphine discontinuation

Abstract

AbstractIntroductionPrescription opioid use is not recommended in individuals with a history of opioid use disorder. Still, patients often experience pain or craving after buprenorphine discontinuation leading to opioid use. As complete, accessible, patient level records of controlled substance use, prescription monitoring programs (PMPs) may offer a useful tool to recognize recent treatment with buprenorphine and prevent new opioid use.ObjectiveThe objective of this study was to estimate the incidence of new opioid use after buprenorphine discontinuation and to measure the rate of provider and pharmacist PMP query prior to dispensing opioid analgesics to individuals with a recent history of buprenorphine treatment.MethodsA cohort of patients who initiated and discontinued a buprenorphine product between June 30, 2016 and July 4, 2018 was identified from the Texas PMP. Eligible participants were then followed for an additional 180 days to determine if they filled a prescription for an opioid medication after discontinuation. Records of PMP query were then used to measure the frequency with which prescribers and pharmacists queried the PMP prior to dispensing an opioid prescription after buprenorphine discontinuation.ResultsOf the 7081 eligible participants, 16.5% filled an opioid prescription after treatment discontinuation. Pharmacists or prescribers checked the PMP prior to prescribing or dispensing in only 116 of these 1169 instances (9.9%). Of those who filled an opioid prescription after discontinuation, 36.8% did so at a pharmacy where they previously filled a buprenorphine prescription.ConclusionsA considerable number of patients filled an opioid prescription after buprenorphine discontinuation. Despite the availability of the PMP, prescribers and pharmacists rarely use it when deciding whether to dispense an opioid prescription to an individual who recently discontinued buprenorphine. Reform focused on PMP workflow integration and usability may be a useful tool to reduce opioid use after buprenorphine discontinuation.