Impact Of Prescription Drug Monitoring Programs Research Articles

Where Does It Hurt? The Impact of Prescription Drug Monitoring Programs on Pain Management in Home Health Care

As states pass regulations to curb opioid abuse, what are the consequences for legitimate pain management? Forty-nine states have adopted prescription drug monitoring programs (PDMP) to detect potentially inappropriate opioid prescribing and use. Several studies have estimated the impact of PDMPs in reducing abuse and deaths. However, no study addresses an equally important question — do PDMPs generate negative or positive spillover effects for pain management in the millions of Americans suffering from pain? We use 2003-2013 home health agency-level panel data to assess the effect of PDMPs on pain improvements in home health patients. We hypothesize that implementation of a PDMP in the context of home health care may induce agencies to substitute away from opioids to other (potentially more effective) treatments, such as physical therapy. Using a fixed effects, two-stage least squares model, we estimate pain improvements as a result of whether a state has implemented a PDMP and control for endogeneity between state policies and pain management practices. We find that home health agencies in states with PDMPs are on average more successful at improving pain in their patients. However, the effect varies according to how the agencies are reimbursed for services. Our results suggest that home health agencies are adapting their models of care to state opioid policies, and the incentives embedded in reimbursement systems can either promote better or worse pain management.

Impact of prescription drug-monitoring program on controlled substance prescribing in the ED

ObjectiveIn 2009, Florida initiated a statewide prescription drug-monitoring program (PDMP) to encourage safer prescribing of controlled substances and reduce drug abuse and diversion. Data supporting the utility of such programs in the emergency department (ED) is scarce. This study sought to determine the effect of PDMP data on controlled substance prescribing from the ED. MethodsIn this pre-post study utilizing a historical control, pharmacists in the ED provided prescribers with a summary of the PDMP data for their patients. The number of controlled substances prescribed in the intervention group was compared with that prescribed in the historical control to determine if the intervention resulted in a change in the average number of controlled substance prescribed. ResultsAmong the 710 patients evaluated, providing prescribers with PDMP data did not alter the average number of controlled substance per patient prescribed (0.23 controlled substances per patient in the historical control compared with 0.28 controlled substances per patient in the intervention group; 95% confidence interval [CI], −0.016 to 0.116; P = .125). All prescribers surveyed indicated that having PDMP data altered their controlled substance prescribing and felt more comfortable prescribing controlled substances. ConclusionsAlthough the results did not demonstrate a change in the average number of controlled substances prescribed when prescribers were provided with PDMP data, results from the survey indicate that prescribers felt the data altered their prescribing of controlled substances, and thus were more contented prescribing controlled substances.

Prescription drug monitoring and drug overdose mortality.

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.

Prescription Drug Monitoring and Dispensing of Prescription Opioids

In the United States, per-capita opioid dispensing has increased concurrently with analgesic-related mortality and morbidity since the 1990s. To deter diversion and abuse of controlled substances, most states have implemented electronic prescription drug monitoring programs (PDMPs). We evaluated the impact of state PDMPs on opioid dispensing. We acquired data on opioids dispensed in a given quarter of the year for each state and the District of Columbia from 1999 to 2008 from the Automation of Reports and Consolidated Orders System and converted them to morphine milligram equivalents (MMEs). We used multivariable linear regression modeling with generalized estimating equations to assess the effect of state PDMPs on per-capita dispensing of MMEs. The annual MMEs dispensed per capita increased progressively until 2007 before stabilizing. Adjusting for temporal trends and demographic characteristics, implementation of state PDMPs was associated with a 3% decrease in MMEs dispensed per capita (p=0.68). The impact of PDMPs on MMEs dispensed per capita varied markedly by state, from a 66% decrease in Colorado to a 61% increase in Connecticut. Implementation of state PDMPs up to 2008 did not show a significant impact on per-capita opioids dispensed. To control the diversion and abuse of prescription drugs, state PDMPs may need to improve their usability, implement requirements for committee oversight of the PDMP, and increase data sharing with neighboring states.