Prescription drug monitoring and drug overdose mortality.

Guohua Li,James Giglio,Barbara H Lang,Charles Dimaggio,Hannah Wunsch,Joanne E Brady

doi:10.1186/2197-1714-1-9

Abstract

BackgroundAbuse of prescription drugs, particularly opioid analgesics, has become a major source of injury mortality and morbidity in the United States. To prevent the diversion and misuse of controlled substances, many states have implemented prescription drug monitoring programs (PDMPs). This study assessed the impact of state PDMPs on drug overdose mortality.MethodsWe analyzed demographic and drug overdose mortality data for state-quarters with and without PDMPs in 50 states and the District of Columbia during 1999–2008, and estimated adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) of drug overdose mortality associated with the implementation of state PDMPs through multivariable negative bionomial regression modeling.ResultsDuring the study period, annual national death rates from drug overdose increased by 96%, from 5.7 deaths per 100,000 population in 1999 to 11.2 in 2008. The impact of PDMPs on drug overdose mortality varied greatly across states, ranging from a 35% decrease in Michigan (aRR = 0.65; 95% CI = 0.54–0.77) to a more than 3-fold increase in Nevada (aRR = 3.37; 95% CI = 2.48–4.59). Overall, implementation of PDMPs was associated with an 11% increase in drug overdose mortality (aRR = 1.11; 95% CI = 1.02–1.21).ConclusionsImplementation of PDMPs did not reduce drug overdose mortality in most states through 2008. Program enhancement that facilitates the access and use of prescription drug monitoring data systems by healthcare practitioners is needed.Electronic supplementary materialThe online version of this article (doi:10.1186/2197-1714-1-9) contains supplementary material, which is available to authorized users.

Highlights

Abuse of prescription drugs, opioid analgesics, has become a major source of injury mortality and morbidity in the United States
The excess mortality from drug overdose was more pronounced in state-quarters with prescription drug monitoring programs (PDMPs) that were governed by pharmacy boards, that had the statutory authority to monitor non-controlled substances, or that imposed no expectation on practitioners to access the statewide electronic database of dispensed prescriptions (Table 1)
Multivariable modeling revealed that implementation of PDMPs was associated with an 11% increase in drug overdose mortality, with the greatest increase observed in PDMPs that imposed no expectation on practitioners

Summary

Introduction

Opioid analgesics, has become a major source of injury mortality and morbidity in the United States. Drug overdose has become a leading cause of injury mortality and morbidity in the United States, resulting in more than 34,000 deaths and 1.2 million emergency department visits each year (Centers for Disease Control and Prevention CDC 2012a; Substance Abuse and Mental Health Services Administration SAMHSA 2010a). Of the total mortality from drug overdose where a drug was specified, almost three-quarters involved one or more prescription drug (Centers for Disease Control and Prevention CDC 2011). Retail outpatient pharmacy sales, which in 2007 accounted for 80% of the total consumption of opioid analgesics and benzodiazepines, showed marked increases between 1998 and 2007 (Food and Drug Administration FDA 2010). Increases in controlled substance prescribing and retail sales were associated with more use; per capita consumption of opioid analgesics quadrupled from 74 milligrams in 1997 to 369 milligrams in 2007 (Manchikanti and Singh 2008)

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Discussion

Conclusion