Prescribing Of Controlled Substances Research Articles

Implementing Electronic Prescription of Controlled Substances at a Tertiary Care Pediatric Hospital : Unanticipated Effects and Provider Perceptions

BACKGROUND AND OBJECTIVES There has been slow adoption of electronic prescribing of controlled substances (EPCS) due to cost concerns and cumbersome technological and security specifications required by the DEA. The objective of this study was to assess the effects of an EPCS implementation at a tertiary care pediatric hospital on prescribing patterns and providers’ perceptions of this functionality pre and post implementation. METHODS The prescribing patterns of both the pilot group and the institution as a whole were analyzed before and after implementation. A survey was distributed to …

The Complementarity of Health Information & HIT For Reducing Opioid-Related Mortality and Morbidity

In response to the opioid crisis, each U.S. state has implemented a prescription drug monitoring program (PMP) to provide health providers with patients’ controlled substance prescription informati...

Advanced visualizations to interpret prescription drug monitoring program information

ObjectivesPrescription drug monitoring programs (PDMPs) are state-based databases that contain information about controlled substance prescriptions dispensed by pharmacies. Many states now mandate PDMP use by prescribers, despite unclear effectiveness. We hypothesize that it is possible to improve the interpretability, and hence effectiveness, of PDMPs by enhancing them. MethodsThis was a real-time simulation of an enhanced PDMP. Fifty practicing physicians (25 primary care, 25 emergency medicine) were randomized to see three cases with a standard profile or an enhanced profile that included graphical representation of prescriptions and identified risky prescribing patterns. After a two-month washout period, participants were placed in the opposite group. ResultsPhysicians presented with the enhanced profile were more likely to correctly identify patients with multiple providers (97.0% vs. 85.8%, p = 0.002), overlapping opioid and benzodiazepine prescriptions (94.7% vs. 87.5%, p = 0.03), overlapping opioid prescriptions (89.5% vs. 70.8%, p < 0.01), high daily dosages of opioids (99.2% vs. 25.0%, p = 0.02), and traveling to distant pharmacies (79.7% vs. 2.5%, p < 0.01). There was no difference in interpretation time for the three cases (standard profile 657.3 s vs. enhanced profile 686.3 s, p = 0.31). ConclusionsA simulated PDMP with graphical displays and interpretation of findings was, for this cohort of emergency physicians and primary care physicians, associated with an increased ability to determine high-risk features on PDMP profiles.

Controlled substance prescribing and education in orthopedic residencies: A program director survey

BackgroundOpioid misuse is currently plaguing the US. Efforts to reduce this include opioid prescribing education (OPE). Orthopaedic residents often prescribe opioids but, their education is unknown. MethodsA survey was sent to orthoapedic residency program directors (PDs) regarding their program's controlled substance (CS) policies and knowledge of local CS regulations. ResultsThere were 60 (36.8%) completed surveys. 54 (90.0%) programs allow resident outpatient opioid prescribing. Nine (16.7%) programs require individual DEA registration and 7 (13.0%) were unsure about DEA registrations. State laws regarding PDMP utilization and OPE for fully licensed physicians were correctly answered by 52 (86.7%) and 43 (71.6%), respectively.27 (45.0%) programs had a mandatory OPE. Six (10.0%) PDs were unsure about a mandatory OPE. 16 (48.5%) programs that did not confirm an OPE were considering adding one. ConclusionsThe majority of programs permit residents outpatient opioid prescribing; less than half provide mandatory OPE. Several PDs were unaware local CS prescribing regulations and education. This study demonstrates opportunities to improve OPE among orthopaedic residencies and PDs’ knowledge regarding CS regulations.

Perceptions and Utilization of Prescription Drug Monitoring Programs: A Survey of ACOG members [1Q

INTRODUCTION: ACOG Committee Opinion 711 addresses opioid use in pregnancy and recommends utilization of Prescription Drug Monitoring Programs (PDMPs) before prescribing opioids to any patient. According to the US Centers for Disease Control and Prevention, PDMPs (electronic databases that track controlled substance prescriptions) can inform clinical practice and are primary prevention tools for drug abuse/diversion and neonatal abstinence syndrome (NAS). An increasing number of states mandate PDMP use; however, little is known about how specific physician specialties perceive and use PDMPs. The purpose of this study was to query ACOG member perceptions and utilization of their state PDMP. METHODS: ACOG District XII Committee on Health Care for Underserved Women distributed a voluntary anonymous email survey to 5,000 ACOG members (adjusted participants n=1,470, minus unread/bounced/opt-out). The survey instrument was developed by an OB/GYN and health services researcher workgroup to assess perceptions and utilization of PDMPs. Adjusted response rate=27% (n=397). RESULTS: Most (78%) were registered with their PDMP and 52% agreed that ...mandating physician use of the PDMP was a “good idea.” Most respondents agreed that the PDMP is a primary prevention tool for drug abuse/diversion (70%), addiction (68%), and/or doctor shopping (63%), but few agreed that it was an NAS primary prevention tool (22%). Respondents use the PDMP for patients currently using opioids (33%), and for patients suspected of drug abuse (29%). In qualitative responses, some reported frustration with PDMPs. CONCLUSION: ACOG members are diverse in their perceptions regarding the utility and purpose of PDMPs. Increased education is needed regarding clinical utility of PDMPs.

5D Investigation of Decision-making in Prescription Drug Monitoring Program Use: A Factorial Survey Experiment

The National Institute on Drug Abuse has stated that the increase in availability of prescription opioids for the treatment of pain has contributed to the rise in opioid misuse and diversion. In response to this increase, states have implemented Prescription Drug Monitoring Programs (PDMPs) so that healthcare providers can access the controlled substance prescription history of their patients. There is some evidence that PDMPs have been successful in decreases in deaths from overdose. The goals of PDMPs are to reduce opioid abuse, decrease opioid diversion, and help identify when substance treatment is warranted. The purpose of this presentation is to provide preliminary data on a study is to determine what factors most influence a health care provider's decision to consult the Prescription Drug Monitoring Program database (PDMP). Currently, in most states, it is the provider's discretion on when to consult the PDMP for prescribing or dispensing controlled substances. There is a gap in knowledge about the circumstances that lead to PDMP use, including the role implicit biases plays in determining access of the PDMP prior to prescribing or dispensing opioids for pain. The clinical significance of this study is that implicit biases and other subconscious decision-making process could be contributing to health disparities in how controlled substances are prescribed and used. Basic research on patient and provider characteristics associated with PDMP, and provider decision-making is needed to identify if there are implicit biases and what they are. With this knowledge, training and policy changes could be implemented to address non-clinical variation in PDMP use.

Effect of Controlled Substance Use Management on Prescribing Patterns and Health Outcomes Among High-Risk Users.

The misuse of prescription drugs is a serious public health problem. Although controlled substance (CS) prescribing, in particular, opioid analgesics, has recently declined, the volume of prescriptions in 2015 was still 3 times higher than in 1999. To curb the high volume of CS prescribing, a national health plan has implemented a controlled substance utilization management (CSUM) program, a prescriber-focused educational intervention regarding patients at risk for CS misuse. To characterize the effect of the CSUM program on CS prescribing volumes, number of prescribers and other health outcomes (opioid overdoses, all-cause emergency department visits, and all-cause hospitalizations). The CSUM program identified patients who received ≥10 CS prescriptions within any 3-month window for noncancer pain as being high risk for CS misuse and mailed patient medication profiles to their CS prescribers. This retrospective study was conducted on patients whose prescribers were contacted by the CSUM program from January 2014 to December 2015. The reference group included patients with carved-out pharmacy benefits who were 1:1 propensity score matched to the program group. CS prescribing volumes, number of CS prescribers, and other health care utilization measures were assessed in the 6-month pre-intervention (baseline) period and 6-month post-intervention (follow-up) period using difference-in-difference (DID) analysis. After matching, each group had 17,295 patients, and there were no differences in baseline demographic and clinical characteristics. During the follow-up period, the CSUM group had 1.1 fewer prescriptions for CS (mean difference [MD] within group -3.2 vs. -2.1 prescriptions), 21 fewer days of supply (MD -27 vs. -6 days), and 0.2 fewer number of CS prescribers (MD -0.8 vs. -0.6 prescribers) per patient when compared with the reference group; all P values were < 0.001. The reductions in CS prescribing volumes and number of prescribers within the CSUM group were mainly driven by opioid analgesics, with minimal differences in benzodiazepines and stimulants between the 2 groups. The CSUM program had no significant effect on the opioid dosage strength but was associated with a lower rate of all-cause emergency department visits. The CSUM program had a moderate positive effect on reducing CS prescribing volumes and number of CS prescribers compared with a reference group. Beside the focus on patients who have already received 10+ CS prescriptions, there remains a need for more intensive approaches for accelerating targeted declines in CS in general and opioids in particular. Funding for this study was provided by Anthem, which had no role in study design, data interpretation, manuscript development, or the decision to publish. Chen, Ma, Barron, DeVries, and Agiro are employees of HealthCore, a wholly owned subsidiary of Anthem. Horn is an employee of Anthem.

Opioid e-prescribing trends at discharge in a large pediatric health system.

Legitimate opioid prescriptions have been identified as a risk factor for opioid misuse in pediatric patients. In 2014, Pennsylvania legislation expanded a prescription drug monitoring program (PDMP) to curb inappropriate controlled substance prescriptions. The authors' objective was to describe recent opioid prescribing trends at a large, pediatric health system situated in a region with one of the highest opioid-related death rates in the United States and examine the impact of the PDMP on prescribing trends. Quasi-experimental assessment of trends of opioid e-prescriptions, from 2012 to 2017. Multivariable Poisson segmented regression examined the effect of the PDMP. Period prevalence comparison of opioid e-prescriptions across the care continuum in 2016. There were 62,661 opioid e-prescriptions identified during the study period. Combination opioid/non-opioid prescriptions decreased, while oxycodone prescriptions increased. Seasonal variation was evident. Of 110,884 inpatient encounters, multivariable regression demonstrated lower odds of an opioid being prescribed at discharge per month of the study period (p < 0.001) and a significant interaction between passage of the PDMP legislation and time (p = 0.03). Black patients had lower odds of receiving an opioid at discharge compared to white patients. Inpatients had significantly greater odds of receiving an opioid compared to emergency department (Prevalence Odds Ratio 7.1 [95% confidence interval: 6.9-7.3]; p < 0.001) and outpatient (398.9 [355.5-447.5]; p < 0.001) encounters. In a large pediatric health system, oxycodone has emerged as the most commonly prescribed opioid in recent years. Early evidence indicates that a state-run drug monitoring program is associated with reduced opioid prescribing. Additional study is necessary to examine the relationship between opioid prescriptions and race.

Twelve-Step Programs and Spiritual Support at the End of Life.

Experts estimate that over 25 million Americans are in recovery from addiction to alcohol and other drugs. Many will be confronted with a serious progressive illness necessitating palliative care or hospice services. In current literature, substance use disorder has mostly been examined in relation to appropriate symptom assessment and management, opioid risk screening, and controlled substance prescribing practices. However, as hospice and palliative care (HPC) clinicians strive to provide whole person care for the seriously ill, awareness and facilitation of healthy psychosocial-spiritual coping strategies for recovering addicts should enhance such care. One of the more common support mechanisms to support recovery is the 12-step program, based on Alcoholics Anonymous. Twelve-step programs have been shown to provide effective coping strategies, not only to help facilitate ongoing abstinence but also to support other psychosocial-spiritual crises. The HPC providers may help to serve those living with addiction disorders better by assessing not only patient histories of substance use/abuse and other addictive behaviors but by facilitating their ongoing support recovery efforts. Here, we use 2 HPC cases to illustrate the value of 12-step recovery programs in patient support and provide recommendations for enhancing such healthy coping in HPC clinical settings.

Drug Overdose Deaths Among Women Aged 30-64 Years - United States, 1999-2017.

The drug epidemic in the United States continues to evolve. The drug overdose death rate has rapidly increased among women (1,2), although within this demographic group, the increase in overdose death risk is not uniform. From 1999 to 2010, the largest percentage changes in the rates of overall drug overdose deaths were among women in the age groups 45-54 years and 55-64 years (1); however, this finding does not take into account trends in specific drugs or consider changes in age group distributions in drug-specific overdose death rates. To target prevention strategies to address the epidemic among women in these age groups, CDC examined overdose death rates among women aged 30-64 years during 1999-2017, overall and by drug subcategories (antidepressants, benzodiazepines, cocaine, heroin, prescription opioids, and synthetic opioids, excluding methadone). Age distribution changes in drug-specific overdose death rates were calculated. Among women aged 30-64 years, the unadjusted drug overdose death rate increased 260%, from 6.7 deaths per 100,000 population (4,314 total drug overdose deaths) in 1999 to 24.3 (18,110) in 2017. The number and rate of deaths involving antidepressants, benzodiazepines, cocaine, heroin, and synthetic opioids each increased during this period. Prescription opioid-related deaths increased between 1999 and 2017 among women aged 30-64 years, with the largest increases among those aged 55-64 years. Interventions to address the rise in drug overdose deaths include implementing the CDC Guideline for Prescribing Opioids for Chronic Pain (3), reviewing records of controlled substance prescribing (e.g., prescription drug monitoring programs, health insurance programs), and developing capacity of drug use disorder treatments and linkage to care, especially for middle-aged women with drug use disorders.

New Mexico Nurse-Midwives' Controlled Substance Prescribing and Monitoring Practices.

New Mexico, a state with a high incidence of opioid overdose deaths, requires certified nurse-midwives (CNMs) who prescribe controlled substances to use the statewide Prescription Monitoring Program (PMP). This study examined how frequently CNMs who practice in New Mexico and prescribe controlled substances use the PMP and the purposes for which they use it. All CNMs licensed in New Mexico (N = 210) were sent a link to an anonymous online survey. CNM demographics, practice characteristics, and controlled substance prescribing practices were examined. Approximately 40% of CNMs licensed in New Mexico completed the survey (N = 83), 77% of whom (64/83) were providing direct clinical care services. Nearly all who were engaged in clinical care had a US Drug Enforcement Administration registration number and were registered in the PMP (97%; 62/64). Approximately 90% of those respondents (56/62) reported prescribing controlled substances. Approximately 10% (6/62) never logged into the PMP, 40% (25/62) never ran a self-report, and nearly 30% (18/62) reported never checking the PMP for patient alerts. Among those who reported prescribing controlled substances, the percentages who never logged in, never ran a self-report, and never checked for patient alerts were 7% (4/56), 37% (21/56), and 27% (15/56), respectively. Nearly half of those prescribing controlled substances (26/56) did so monthly or more often, but with respect to their own prescribing, approximately one-third of them (9/26) checked the PMP less frequently than every 6 months. Most CNMs in New Mexico are authorized to prescribe controlled substances, but the frequency of prescribing varies, and some CNMs may not be making optimal use of the state PMP for self-reports, for patient alerts, or prior to prescribing a controlled substance. Additional education pertaining to the PMP is needed, as are best practice recommendations for monitoring CNMs' controlled substance prescribing.

SU83 - COMBINATORIAL PHARMACOGENOMIC TESTING IMPROVES GENERALIZED ANXIETY DISORDER TREATMENT RESPONSE AND DECREASES BENZODIAZAPINE USE

Background Controlled substance prescription use and abuse in the United States has become a public health epidemic. Specifically, benzodiazepine abuse in 2013 has increased as much 400 percent since 1996. Generalized Anxiety Disorder (GAD) was the most frequent reason these medications were given, accounting for 56% of prescriptions. Previously, GeneSight, a psychiatric pharmacogenomic decision support tool, was reported to significantly improve depression symptoms in treatment-resistant depression patients, reduce costs associated with prescriptions, and decrease polypharmacy. Methods To evaluate the combinatorial pharmacogenomics report as a tool to treat GAD and reduce the amount of benzodiazepines used, we analyzed data from two separate studies: (1) Individualized Medicine: Pharmacogenetic Assessment and Clinical Treatment (IMPACT) study, a longitudinal pilot research program , where 315 participants with anxiety disorders (N=210 with GAD) and follow-up data on symptom severity using the GAD-7 questionnaire were identified; and (2) MEDCO dataset (Winner et al., 2015; Curr Med Res Opin.;31:1633-43) in which patients (n=660) who were prescribed at least one benzodiazepine six months pre-testing and were followed six months post-testing. Results The analyses in the IMPACT study sample showed that medication treatment decisions congruent with the combinatorial pharmacogenomics GeneSight test results can help guide clinician treatment of GAD and result in significantly more improvement of anxiety symptom severity (congruent: -44.9±35.9% versus non-congruent: -25.5±31.8%; t=2.19; p=0.031). In the MEDCO dataset, we found that 18% (n=116) of the patients originally taking at least one benzodiazepine pre-testing (n=660) ceased their use of benzodiazepines post-testing with a significant decrease in benzodiazepine drug counts and refills after testing (mean count 1.2 vs. 0.9; p Discussion The GeneSight test can lead to more effective treatment of the anxiety symptoms in GAD patients and may lead to beneficial decrease in benzodiazepine use.

Provider and Patient Perceptions of an External Medication History Function.

To determine the awareness and use of an external medication history (EMH) function within an electronic health record and its impact on patient perception of medication adherence. Two self-administered surveys were given: one to providers and one to patients. Participants included providers from an academic medical center and patients from 2 general internal medicine clinics. Of 154 completed provider surveys, 61% were aware the EMH existed. More of the respondents aware of the EMH were primary care and medicine subspecialty providers (79.1%) when compared with surgical providers (20.9%, P < 0.0001). The most common reasons chosen for looking at the EMH included checking for medication adherence (44%), questions about a specific medication (40%), and checking controlled substance prescription history (37%). Of those aware of the EMH, 65% found medications on the EMH that they were not aware their patient was getting filled. Of the 94 patient surveys, 34% felt the EMH feature might change their medication taking behavior, and 48% responded that it already had. Patients with a history of depression and/or anxiety were less likely to report the intent to change their medication taking behavior, OR, 0.34 [95% CI, 0.13-0.87]. An external medication history function can provide further insight about a patient's medication profile and prescription filling. Knowledge attained from the EMH may improve patient safety by helping to uncover nonadherence, dosing discrepancies, and medications prescribed by other providers. Additionally, patient knowledge of this feature might improve medication adherence. Although further studies are needed to obtain objective data, the external medication history function may have significant impact on both providers and patients, and its benefit should be widely publicized.

Prescription Drug Monitoring Programs: Does the Arizona CSPMP Provide More Information than Routinely Collected in an Inpatient Psychiatric Facility?

Background: Prescription drug monitoring programs (PDMPs) have been implemented as tools to help identify misuse of prescription medications. There has been mixed data regarding the efficacy of PDMP, and physician attitudes towards it vary. In an inpatient psychiatric hospital, history of substance use, including prescription medications, and results of urine drug screens (UDS) are obtained during the admission interview. Objectives: The aim was to determine if the substance use history and UDS are sufficient to identify substance use as compared to information obtained by Arizona’s Controlled Substance Prescription Monitoring Program (CSPMP) in an inpatient setting. Methods: A prospective chart review was completed on all newly admitted patients to the behavioral units within a 30-day period to identify those that had substance use disorder. CSPMP records were checked for all subjects for patterns of misuse. The test results were not normally distributed, so non-parametric tests were chosen for analyses. Results: Of the 220 patients admitted, 127 patients had a substance use diagnosis. Out of the 127 patients, 67(30.5 %) were diagnosed with either opioid, benzodiazepine or amphetamine and stimulant use disorder. Of the 125 (56.8%) patients who had a substance use disorder, the substance abuse diagnosis had been made by the psychiatrist in the medical chart. CSPMP identified only 2 (0.8%) additional patients that were missed during the intake. Conclusions: The CSPMP provided little benefit to improving substance abuse detection when compared with the clinical interview and UDS results. This is attributed to the comprehensive evaluation done during the intake.

Utilization of prescription drug monitoring programs for prescribing and dispensing decisions: Results from a multi-site qualitative study.

Prescription drug monitoring programs (PDMPs) track the dispensing of prescription-controlled substances with the goal of mitigating misuse and diversion. Authorized users query the PDMP for controlled substance prescription histories at the point of care. Despite widespread implementation of PDMPs, there is much not known about how PDMPs influence prescribing and dispensing decisions. The objective of this study was to investigate how primary care providers (PCPs) and pharmacists utilize PDMPs when making prescribing and dispensing decisions. Data from in-depth, qualitative interviews with PCPs (n = 48) and community pharmacists (n = 60) across four states- Arkansas, Idaho, Kentucky, and Washington were analyzed for themes around PDMP use. Both PCPs and pharmacists reported that PDMPs are key tools for aiding prescribing and dispensing decisions. PCPs reported variable use of PDMPs with most querying the PDMP when there are "red flags" and fewer reporting having clinic policies that direct PDMP use. Primary care providers in Kentucky reported more consistent and routine use of the PDMP as a result of a state law that mandates query prior to the initial prescribing of Schedule II controlled substances. Community pharmacists practicing in chain pharmacies reported formal policies requiring PDMP query prior to dispensing opioids, while utilization of PDMPs by pharmacists practicing in independently-owned pharmacies was more variable. Pharmacists and PCPs reported barriers to PDMP use, such as having to "log in on a separate machine" and perceived that PDMP utility could be improved by integrating it within pharmacy dispensing systems and electronic health records. Pharmacists and PCPs reported the importance of PDMP information to aid their prescribing and dispensing decisions. Efforts to enhance state PDMP programs should consider processes that seamlessly integrate all available controlled substance prescription history for a given patient at the point of care so that PDMP utility for prescribing and dispensing decisions is maximized.

The Risk of Prolonged Opioid Use Is Low After Hand Surgery Among Opioid, Benzodiazepine, and Sedative/Hypnotic-Naïve Patients

Receipt of Intellectual Property Rights: Dimension Orthotics, LLC (Rivlin) Contracted Research: Miami Device Solutions (Rivlin) Ownership Interest: Wright Medical Inc., Matador, LLC (Beredjiklian), Dimension Orthotics, LLC (Beredjiklian and Rivlin) The prescription of opioids in the United States has dramatically increased since the 1990s. Several states have developed online Prescription Drug Monitoring Programs (PDMPs) aimed at preventing the overuse and overprescribing of controlled substances. We sought to determine the proportion of prolonged opioid use in patients undergoing outpatient hand surgery. We hypothesized that preoperative exposure to opioids, benzodiazepines, and sedative/hypnotics would be directly related to increased opioid use after surgery. Consecutive patients undergoing upper-extremity surgery at one institution were enrolled. The Pennsylvania PDMP Web site was used to document all prescriptions of controlled substances filled 6 months prior to and after the procedure. Patients were grouped into exposed or not-exposed cohorts dependent upon their exposure 6 months prior to surgery. 290 patients were included in the study. Opioid-naïve (ON) patients filled fewer opioid prescriptions than their opioid-exposed (OE) counterparts (P < .001). The likelihood of filling a second opioid prescription was 23.2 times greater in the OE than the ON group (P < .001). Compared to the ON group, patients in the OE group were 7.0 times more likely to fill a benzodiazepine prescription and 6.4 times more likely to fill a sedative/hypnotic prescription (P < .001). Benzodiazepine- and sedative/hypnotic-exposed patients were significantly more likely to fill a controlled substance prescription than their naïve counterparts (P < .001). Patients in the OE group evidenced significantly prolonged opioid use compared to those in the ON group (P < .0001). Surgery was not associated with a change in “use status” of opioids, or sedative/hypnotics in the postoperative compared to the preoperative period. (P = .6). •Patients without exposure to opioid, benzodiazepine or sedative/hypnotic medications are highly unlikely to develop a prolonged need for opioid medication.•Having outpatient hand surgery and having an opioid prescribed does not appear to change the patterns of controlled substances used.•States’ PDMP Web sites may be an important tool for prescribers in the management of this difficult problem.

An Experimental Test of the Effectiveness of Unsolicited Reporting by a Prescription Drug Monitoring Program in Reducing Inappropriate Acquisition of Opioids.

This research looked at whether notifying prescribers and pharmacies about patients who use multiple providers to obtain opioids reduces their prescribing activity (including use of multiple providers, numbers of opioid prescriptions, or amounts of opioids obtained). Nevada's prescription drug monitoring program (PDMP) identified patients using multiple providers to obtain opioids and assigned them alternately to an intervention or control group. Controlled substance prescription histories were sent only to intervention patients' providers. Subsequent opioid purchases by patients in both groups were compared. All pharmacies and dispensers in the state are required to report every prescription for Schedule II-IV opioids dispensed to the PDMP. All patients receiving opioids from more than four different Nevada prescribers and more than four pharmacies during the previous six months assigned to the intervention (N = 436) or control group (N = 441). We used ordinary least squares regression to estimate notification effects on each outcome, accounting for preexisting differences among groups. Providers receiving unsolicited notices were 13% less likely to continue prescribing to patients than providers not notified. Eighty-four percent of the intervention patients' prescribers discontinued prescribing to them after assignment, compared with 80.5% of the control group's prescribers-who were not notified. Because patients in both groups found other prescribers to replace discontinued prescribers, notification had at most a small effect on patients' use of multiple providers, numbers of opioid prescriptions, or amounts of opioids purchased. Requiring prescribers to solicit patients' prescription histories is likely to be a more effective use of PDMP resources than proactive notification.

Heroin Overdose Hospitalization Risk due to Prescription Opioids using PDMP in WI.

Objective: Using the Wisconsin Enhanced Opioid Surveillance System, the present study evaluates the heroin hospitalization risk among the opioid recipients using the Prescription Drug Monitoring Data (PDMP) with following specific objectives:1. Evaluate the risk of heroin overdose hospitalization following the prescription of opioid.2. Assess the time elapsed between last prescribed opioid and first heroin overdose hospitalization.3. Identify the main predictors of heroin overdose hospitalization among prescribed opioid users.Introduction: Nationally and in Wisconsin, heroin is the leading cause of opioid related death and hospitalization. Opioids are commonly prescribed for pain. Every day, over 1,000 people are treated in emergency departments for misusing prescription opioids1. In 2015, more than 15,000 people died from overdoses involving prescription opioids1. Approximately, three out of four heroin users report having abused prescription opioids prior to using heroin2. In Wisconsin from 2010 to 2014 the number of deaths involving any opioid increased by 51% and for heroin increased by 192%. Through the federal government funding and support Wisconsin has established a statewide tool to help combat the ongoing prescription drug abuse epidemic by providing valuable information about controlled substance prescriptions that are dispensed in the state. PDMP is continue to be among the most promising state-level interventions to improve opioid prescribing, inform clinical practice, and protect patients at risk.Methods: This was a Retrospective cohort study of PDMP patients who were prescribed an opioid and were subsequently hospitalized for heroin overdose between 2013 and 2015. Our analysis used a combination of univariate and survival data analysis to estimate the risk of heroin overdose hospitalization from the time of the last prescribed opioid to the first day of hospitalization.The outcome was defined as Heroin Hospitalization with any code of 965.01 (ICD9 2013 first quarter to third quarter of 2015), T40.1X1A, T40.1X4A (ICD10 fourth quarter of 2015).The exposure was defined as Prescription of Opioid limited to DEA class I, II, III, &amp; IV.Our analysis used a combination of univariate and survival data analysis to estimate the risk of heroin hospitalization from the time of the last prescribed opioid to first day of hospitalization due to heroin overdose. Cox Regression Hazard modeling was used to analyze survival time data and to identify the main predictors of heroin hospitalization.Data were analyzed using the SAS 9.2 and the study was initiated with the Data Governance Board Approval.Results: From 2013 to 2015, a total of 1,397,493 unique patients that were hospitalized linked to 1,448,224 patients reported in the PDMP who received controlled substance. Among those 699,014 (48%) had at least one hospitalization event and out of those 396 (6%) had at least one hospitalization episode due to heroin. Annual ED visit rates due to heroin overdose have doubled from 179 in 2013 to 396 in 2015. On average, people who stopped receiving prescription drugs were at a 72% increased risk of being hospitalized for heroin overdose within five months with Log-Rank Test significance (p=0.01). Males, 90 morphine milligram equivalent recipients, and kidney disease morbidity were 3.63, 2.99, and 5.64 times higher risk to have heroin overdose hospitalization, respectively.Conclusions: Patients with a history of stopping prescription drugs within the previous five months are at higher risk for subsequent hospitalization for heroin overdose. Factors such as alcohol use, age,gender, and tapering of prescription influence the risk of heroin hospitalization. It may be prudent to transition patients to alternative treatments before they become addicted to the prescribed drugs.

Physician Time Burden Associated with Querying Prescription Drug Monitoring Programs.

Prescription drug monitoring programs (PDMPs) enable prescribers to review patient prescription histories, and their use is mandatory in many states. We estimated the cost of physicians retrieving PDMP patient reports compared with a model where a delegate (i.e., administrative staff) retrieves reports. We performed a cost analysis with a one-year time horizon, from the perspective of physicians' employers. We obtained specialty-specific estimates of controlled substance prescribing frequency from the National Ambulatory Medical Care Survey, 2012-2014. We defined three PDMP usage cases based on the frequency of queries: comprehensive (before every Schedule II-IV controlled substance prescription), selective (before new Schedule II-IV prescriptions and every six months for continuing medications), and minimal (before new Schedule II or III prescriptions and annually for continuing medications). The delegate model was less costly for all specialties in the comprehensive usage case and most specialties in the selective usage case, and it was similar to physician model costs in the minimal usage case. Estimated annual costs of the physician model to a large health care system (1,000 full-time equivalent physicians) were $1.6 million for comprehensive usage, $1.1 million for selective usage, and $645,313 for minimal usage. The delegate model was less costly in the comprehensive (savings of $907,283) and selective usage cases (savings of $156,216). Relying on delegates vs physicians to retrieve reports is less costly in most cases. Automation and integration of PDMP data into electronic health records may reduce costs further. Physicians, health care systems, and states should collaborate to streamline access to PDMPs.

The Impact of the U.S. Drug Enforcement Agency Schedule Changes for Hydrocodone and Tramadol on California Prescriptions Patterns

The Impact of the U.S. Drug Enforcement Agency Schedule Changes for Hydrocodone and Tramadol on California Prescriptions Patterns