Implementation Of Prescription Drug Monitoring Programs Research Articles

S86 - Changes in Opioid and Other Analgesic Prescribing Following Voluntary and Mandatory Prescription Drug Monitoring Program Implementation: A Time Series Analysis

S86 - Changes in Opioid and Other Analgesic Prescribing Following Voluntary and Mandatory Prescription Drug Monitoring Program Implementation: A Time Series Analysis

T96 - Changes in Opioid Agonist Treatment Initiation Following Voluntary and Mandatory Prescription Drug Monitoring Program Implementation: A Time Series Analysis

T96 - Changes in Opioid Agonist Treatment Initiation Following Voluntary and Mandatory Prescription Drug Monitoring Program Implementation: A Time Series Analysis

Prescription drug monitoring program mandates and opioid prescriptions received by patients dying of cancer.

11003 Background: Strong consensus supports opioid analgesics as first-line pain management for patients with poor prognosis cancer approaching the end of life (EoL). State legislations that mandate prescriber access of Prescription Drug Monitoring Programs (PDMPs) when prescribing opioids intend to mitigate unsafe opioid prescriptions but may have unintended consequences in restricting access to opioids for patients dying from cancer. This study seeks to assess associations between state implementation of comprehensive PDMP mandates –applicable to all prescribers and all clinical settings and not allowing prescriber discretion – with opioid prescriptions received by patients dying of cancer. Methods: We used SEER cancer registry linked with Medicare fee-for-service claims to identify 184,123 Medicare beneficiaries 66 years or older who died of cancer in 2011-2019 in one of 10 SEER states with an operating PDMP by the beginning of 2011. We measured opioid prescriptions dispensed to patients near the EoL, defined as 30 days prior to death or hospice admission. We exploited staggered implementation of comprehensive PDMP mandates and assessed the association of such implementation with opioid prescriptions dispensed to patients near the EoL. We estimated logistic regressions for dichotomous outcomes and Generalized Linear Models for continuous outcomes. Results: Implementation of comprehensive PDMP mandates was associated with a reduction in the rate of 1 or more opioid days near the EoL from 47.2% to 45.2% (difference, 0.02 [95% CI, -0.027, -0.012]), a reduction in the rate of 1 or more long-acting opioid days from 15.8% to 14.7% (difference, 0.011 [95% CI, -0.016, -0.006]), and a reduction of 130.8 (95% CI, -161.5, -100.2) in total morphine milligram equivalents (MMEs) and of 135.6 (95% CI, -215.1, -56.1) in MMEs from long-acting opioids among patients who received 1 or more days of opioids/long-acting opioids. Conclusions: Comprehensive PDMP mandates were associated with 4-9% reduction in opioid prescriptions dispensed to patients at the EOL. Specific strategies are needed to effectively exempt patients with active cancer from such mandates. [Table: see text]

Association of state-level prescription drug monitoring program implementation with opioid prescribing transitions in primary care in Australia.

This study aimed to evaluate whether voluntary and mandatory prescription drug monitoring program (PDMP) use in Victoria, Australia, had an impact on prescribing behaviour, focusing on individual patients' prescribed opioid doses and transition to prescribing of nonmonitored medications. This was a retrospective cross-sectional study using routinely collected primary healthcare data. A 90-day moving average prescribed opioid dose in oral morphine equivalents was used to estimate opioid dosage. A Markov transition matrix was used to describe how patients prescribed medications transitioned between opioid dose groups and other nonopioid treatment options during 3 transition periods: transition between 2 control periods prior to PDMP implementation (T1 to T2); during the voluntary PDMP implementation (T2 to T3); and during mandatory PDMP implementation (T3 to T4). Among patients prescribed opioids in our study, we noted an increased probability of transitioning to not being prescribed opioids during the mandatory PDMP period (T3 to T4). This increase was attributed mainly to the ceasing of low-dose opioid prescribing. Membership in an opioid dose group remained relatively stable for most patients who were prescribed high opioid doses. For those who were only prescribed nonmonitored medications initially, the probability of being prescribed opioids increased during the mandatory PDMP when compared to other transition periods. The introduction of PDMP mandates appeared to have an impact on the prescribing for patients who were prescribed low-dose opioids, while its impact on individuals prescribed higher opioid doses was comparatively limited.

Changes in opioid agonist treatment initiation among people prescribed opioids for pain following voluntary and mandatory prescription drug monitoring program implementation: A time series analysis.

Prescription drug monitoring programs (PDMP) are increasingly used to identify people prescribed high-dose opioids. However, little is known about whether PDMPs impact opioid agonist treatment (OAT) uptake, the gold standard for opioid use disorder. This study examined the impact of PDMP implementation on OAT initiation among people prescribed opioids, in Victoria, Australia. De-identified electronic records from all 464 Victorian general practices included in the POLAR database were used. OAT initiation was defined as a new OAT prescription between 1 April 2017 and 31 December 2020, with no OAT prescriptions in the year prior. Interrupted time series analyses were used to compare outcomes before (April 2017 to March 2019) and after (April 2019 to December 2020) PDMP implementation. Binary logistic regression was used to examine differences in patients' characteristics associated with OAT initiation prior to and after PDMP implementation. In total, 1610 people initiated OAT, 946 before and 664 after PDMP implementation. No significant immediate (step) or longer-term (slope) changes in the rates of OAT initiation were identified following PDMP implementation, after adjusting for seasonality. A high opioid dose (>100 mg oral morphine equivalent) in the 6-months prior to OAT initiation was the only significant characteristic associated with reduced odds of OAT initiation post-PDMP implementation (odds ratio 0.29; 0.23-0.37). PDMP implementation did not have a significant impact on OAT initiation among people prescribed opioids. Findings suggest additional clinical initiatives that support OAT initiation are required to ensure PDMPs meet their intended target of reducing opioid-related harms.

Changes in opioid and other analgesic prescribing following voluntary and mandatory prescription drug monitoring program implementation: A time series analysis of early outcomes.

Australian prescription drug monitoring programs (PDMPs) provide information about a patient's recent medication history for controlled drugs at the point of prescribing and dispensing. Despite their increasing use, the evidence for PDMPs is mixed, and is almost exclusively from the United States. This study examined the impact of PDMP implementation on opioid prescribing among general practitioners in Victoria, Australia. We examined data on analgesic prescribing using electronic records of 464 medical practices in the Australian state of Victoria between 01/04/2017 and 31/12/ 2020. We used interrupted time series analyses, to examine immediate and longer-term trends in medication prescribing following voluntary (from April 2019) and mandatory PDMP implementation (from April 2020). We examined changes in three outcomes (i) 'high' opioid dose (50-100mg oral morphine equivalent daily dose (OMEDD) and over 100mg (OMEDD) prescribing (ii) prescribing of high-risk medication combinations (opioids with either benzodiazepines or pregabalin), and (iii) initiation of non-controlled pain medications (tricyclic antidepressants, pregabalin and tramadol). We found no effect of voluntary or mandatory PDMP implementation on 'high-dose' opioid prescribing with reductions only seen in those prescribed <20mg OMEDD (i.e., the lowest dose category). Co-prescribing of opioids with benzodiazepines (additional 11.87 [95%CI 2.04 to 21.67] patients/10,000 and pregabalin (additional 3.54 [95% CI 0.82 to 6.26] patients/10,000 increased following mandatory PDMP implementation among those prescribed opioids. In contrast to trends of reduced initiation prior to PDMP implementation, we found increased new initiation of non-monitored medications following PDMP implementation (e.g., an immediate increase of 2.32 [95%CI 0.02 to 4.54], patients/10,000 received pregabalin and 3.06 [95%CI 0.54 to 5.5] patients/10,000 received tricyclic antidepressants after mandatory PDMP implementation), and increased tramadol initiation during the voluntary PDMP period (an increase of 11.26 [95%CI: 5.84, 16.67] patients /10,000). PDMP implementation did not appear to reduce prescribing of high opioid doses or high-risk combinations. Increased initiation of tricyclic antidepressants, pregabalin and tramadol may indicate a possible unintended effect.

Association of Prescription Drug Monitoring Programs With Opioid Prescribing and Overdose in Adolescents and Young Adults.

Prescription opioid use is associated with substance-related adverse outcomes among adolescents and young adults through a pathway of prescribing, diversion and misuse, and addiction and overdose. Assessing the effect of current prescription drug monitoring programs (PDMPs) on opioid prescribing and overdoses will further inform strategies to reduce opioid-related harms. We performed interrupted time series analyses to measure the association between state-level implementation of PDMPs with annual opioid prescribing and opioid-related overdoses in adolescents (13 to 18 years) and young adults (19 to 25 years) between 2008 and 2019. We focused on PDMPs that included mandatory reviews by providers. Data were obtained from a commercial insurance company. Among 9,344,504 adolescents and young adults, 1,405,382 (15.0%) had a dispensed opioid prescription, and 6,262 (0.1%) received treatment for an opioid-related overdose. Mandated PDMP review was associated with a 4.2% (95% CI, 1.9% to 6.4%) reduction in annual opioid dispensations among adolescents and a 7.8% (95% CI, 4.7% to 10.9%) annual reduction among young adults. For opioid-related overdoses, mandated PDMP review was associated with a 16.1% (95% CI, 3.8 to 26.7) and 15.9% (95% CI, 7.6 to 23.4) reduction in annual opioid overdoses for adolescents and young adults, respectively. PDMPs were associated with sustained reductions in opioid prescribing and overdoses in adolescents and young adults. Although these findings support the value of mandated PDMPs as part of ongoing strategies to reduce opioid overdoses, further studies with prospective study designs are needed to characterize the effect of these programs fully.

Association of prescription drug monitoring programs with benzodiazepine prescription dispensation and overdose in adolescents and young adults

Introduction Prescription drug monitoring programs are state-run databases designed to support safe prescribing of controlled substances and reduce prescription drug misuse. We analyzed healthcare claims data to determine the association between prescription drug monitoring programs with mandated provider review and adolescent and young adult benzodiazepine prescription dispensing and overdose. Methods We performed a state-level retrospective cohort study to evaluate the association between implementation of prescription drug monitoring programs with mandated provider review and benzodiazepine prescription dispensing and benzodiazepine-related overdoses among adolescents (13–18 years) and young adults (19–25 years) between 1 January 2008 and 31 December 2019. Data were obtained from a United States commercial health insurance company. Results There were 74,539 (1.8%) adolescents and 246,760 (4.0%) young adults with at least one benzodiazepine prescription dispensed. Benzodiazepine overdoses occurred among 1,569 (0.04%) and 3,202 (0.05%) adolescents and young adults, respectively. Implementation of a prescription drug monitoring program with mandated provider review was associated with a 6.8% (95% CI, 1.6–11.8) yearly reduction in benzodiazepine prescription dispensing among adolescents and a 12.5% (95% CI, 9.3–15.5) yearly reduction among young adults. There was no decrease in benzodiazepine overdoses in either age group (-15.4% [95% CI, −21.5 to 3.0] and −8.0% [95% CI, −18.0 to 3.2] yearly change in adolescents and young adults, respectively). Discussion Consistent with prior work, our study did not find an association between prescription drug monitoring program implementation and reduction in benzodiazepine-related overdoses among adolescents and young adults. However, the substantial reduction in benzodiazepine prescription dispensing is encouraging. Conclusion Prescription drug monitoring programs were associated with decreases in benzodiazepine prescription dispensing, but not benzodiazepine-related overdoses in this cohort of adolescents and young adults. These findings serve to inform development of further policies to address rising rates of benzodiazepine misuse and overdose in this patient population.

The Hazards of Unwinding the Prescription Opioid Epidemic: Implications for Child Maltreatment

Child maltreatment has significant and long-lasting consequences. We examine how two interventions designed to curtail prescription opioid misuse, the reformulation of OxyContin and the implementation of must-access prescription drug monitoring programs (PDMPs), affected child maltreatment. Our results suggest counties with greater initial rates of prescription opioid usage experienced relatively larger increases in child physical abuse and neglect after OxyContin’s reformulation. We also find some evidence of increases in alleged physical abuse and neglect due to must-access PDMP implementation. Our results uncover unintended consequences for children of reducing the supply of an addictive good without adequate support for dependent users. (JEL I12, I18, J13, K32, K42, L65)

Impact of Mandated Online Prescription Drug Monitoring Programs on Opiate Analgesic Use and Patient-Reported Pain during Radiotherapy for Oropharyngeal Cancer

<h3>Purpose/Objective(s)</h3> Owing to the dramatic rise in opiate-related deaths, the use of online prescription drug monitoring programs (PDMPs) concurrent with new laws restricting opiate administration has become commonplace across the U.S. Some oncologists, however, have expressed concerns that they may unintentionally limit treatment access to at-risk oncology populations. As opiates are frequently used in the acute management strategies for those undergoing radiotherapy for squamous cell carcinoma of the oropharynx, we sought to evaluate changes in short-term opiate prescription use following the implementation of mandated use of an online PDMP in an outpatient radiation oncology practice. <h3>Materials/Methods</h3> Between July of 2017 and December of 2019, 64 patients with biopsy-confirmed oropharyngeal squamous cell carcinoma undergoing curative-intent radiotherapy were evaluated and divided into two cohorts: (1) 26 patients treated 1 year before and (2) 38 patients treated 1.5 years following mandated PDMP use and implementation of new opiate prescription laws. The primary endpoint was opiate prescriptions during therapy and within 3 months after therapy as well as patient-reported pain per the Defense and Veterans Pain Rating Scale. Opiate doses were treated as the response in a series of chi-square tests using a three-level format: no vs. 40 to 3000 vs. 3000+ MME. Cochran-Mantel-Haenszel chi-square analysis with the row mean score test statistic assessed any proportional shifts in dose rates between strata of selected prognostic factors. <h3>Results</h3> The median total opiate doses were 975 MME and 1025 MME in the pre- and postintervention groups with no significant differences in MMEs prescribed (p=0.8441). There was also no difference in patient-reported uncontrolled pain (p=0.38) between the treatment cohorts. Univariate analysis showed tonsillar/soft-palate subsite (p<0.01) and alcohol use (p=0.04) were associated with higher rates of prescribed opioids. While 75% of patients (n=48) received opiates during their acute care, 78% (n=50) were off all prescription narcotics by 3 months or sooner following treatment. <h3>Conclusion</h3> Although potential concerns that mandated PDMP use would affect opiate utilization, there was no associated change in total opiate use by MME for the management of acute pain during radiotherapy for patients with oropharyngeal squamous cell carcinoma nor differences in patient-reported uncontrolled pain. Furthermore, despite high utilization of opiates during radiotherapy, few patients continued use past 3 months after treatment.

Must‐access prescription drug monitoring programs and retail opioid sales

AbstractThis paper examines the effect of prescription drug monitoring programs (PDMPs) on the retail sales of eight commonly prescribed opioids in the United States. Specifically, we exploit variation in state‐level policies to identify states with “must‐access” versus voluntary PDMPs. Our results suggest that must‐access PDMP implementation does not uniformly reduce prescription retail opioid sales. We also find evidence that must‐access PDMP implementation does not affect the retail sales of two treatment drugs, methadone and buprenorphine. These results suggest that policymakers should consider PDMP implementation as part of a broader response to the opioid crisis rather than a singular policy intervention.

Trends in Opioid Prescribing Following Pennsylvania Statewide Implementation of a Prescription Drug Monitoring Program.

Background: The opioid epidemic is a major public health crisis in the United States. Legislators have enacted various strategies to combat this crisis, including the implementation of statewide prescription drug monitoring programs (PDMP). These PDMPs are electronic databases that collect and analyze patient prescription data on controlled substances, allowing physicians to review prior prescriptions before prescribing. The objective of this study was to determine opioid prescribing patterns after the implementation of a statewide PDMP in Pennsylvania.Methods: After IRB approval, PDMP data were obtained from the Pennsylvania Department of Health. Data obtained included: drug name, days supplied, refill count, and partially filled prescriptions. The study timeline was three years, from first quarter 2017 through first quarter 2020.Results: Over the three years post-implementation of a PDMP, Pennsylvania saw a 33% decrease in the overall quantity of opioid pills prescribed (677,194 absolute reduction), a 9% decrease in partially filled prescriptions (5,821 absolute reduction), and an 18% decrease in authorized refills (525 absolute reduction). Opioid prescriptions for greater than seven days of supply decreased by a larger amount than prescriptions for less than seven days of supply (43% vs 27%). Similarly, prescriptions for more than 22 pills saw a greater decrease than prescriptions for less than 21 days (37% vs 21%). However, the rate of decrease in opioid pills prescribed lessened from 14% in the first two years post implementation, to 10% in the third year. The decrease in partially filled opioid prescriptions for the first two years averaged 14% per year, while it increased by 23% in the third year. An 8% average decrease occurred in the rate of refills for opioid prescriptions for the first two years post implementation, followed by a 3% reduction in the third year.Conclusion: There was a 33% decrease in the overall quantity of opioid pills prescribed in the three years after the implementation of the PDMP. The first two years after implementation saw the largest decreases in prescribing habits, which slowed in the third year. More data are needed to show the long-term effects of implementing a statewide PDMP.

The Effect of Online Prescription Drug Monitoring on Opioid Prescription Habits After Elective Single-level Lumbar Fusion.

The United States opioid epidemic is a well-documented crisis stemming from increased prescriptions of narcotics. Online prescription drug monitoring programs (PDMPs) are a potential resource to mitigate narcotic misuse by tracking controlled substance prescriptions. Therefore, the purpose of this study was to evaluate opioid prescription trends after implementation of an online PDMP in patients who underwent single-level lumbar fusion. Patients who underwent a single-level lumbar fusion between August 27, 2017, and August 31, 2020, were identified and placed categorically into one of two cohorts: an "early adoption" cohort, September 1, 2017, to August 31, 2018, and a "late adoption" cohort, September 1, 2019, to August 31, 2020. This allowed for a 1-year washout period after Pennsylvania PDMP implementation on August 26, 2016. Opioid use data were obtained by searching for each patient in the state government's online PDMP and recording data from the year before and the year after the patient's procedure. No significant difference was observed in preoperative opioid prescriptions between the early and late adoption cohorts. The late adoption group independently predicted decreased postoperative opioid prescriptions (β, 0.78; 95% confidence interval [CI], 0.65 to 0.93; P = 0.007), opioid prescribers (β, 0.81; 95% CI, 0.72 to 0.90; P < 0.001), pharmacies used (β, 0.90; 95% CI, 0.83 to 0.97; P = 0.006), opioid pills (β, 0.61; 95% CI, 0.50 to 0.74; P < 0.001), days of opioid prescription (β, 0.57; 95% CI, 0.45 to 0.72; P < 0.001), and morphine milligram equivalents prescribed (β, 0.53; 95% CI, 0.43 to 0.66; P < 0.001). PDMP implementation was associated with decreased postoperative opioid prescription patterns but not preoperative opioid prescribing behaviors. 4.

Optimization of Prescription Drug Monitoring Program to Overcome Opioid Epidemic in West Virginia.

The development of the Prescription Drug Monitoring Program (PDMP) led to an innovation in the healthcare organization system (HCOs). The PDMP system has been utilized in different states at various organizational levels in an effort to achieve improved health outcomes, reduce the number of prescription drug overdoses, and lighten the economic burden that follows. However, during the implementation of PDMP, there were several barriers and limitations that were discovered. Those barriers impeded the process of utilization of PDMP, such as the complex user interface and lack of training for healthcare providers. The purpose of this paper was to examine the advances and limitations in the utilization and implementation of PDMP in the US healthcare industry and develop strategies for effective use of PDMP in West Virginia.The qualitative part of this paper was a literature review. The paper referred to several peer-reviewed studies and research articles from several reliable resources, which were reached by databases or Google Scholar. A total of 44 articles were reviewed for this study.The implementation of the PDMP was influenced by benefits and barriers. This article reviewed several studies in general that demonstrated positive outcomes from the implementation of PDMP, including a reduced number of prescription drug overdoses, coordinated care for patients, and improved health outcomes. However, the barriers and limitations were not neglected, which mainly include integration of PDMP into the electronic health record (EHR) system, lack of training for the providers, and lack of basic standards for the use of PDMP.Although the new health reforms encouraged the adaption of PDMP among providers, data reporting and data interpretation still remain major concerns for assessing the health outcomes of PDMP implementation.

Surveillance, Self-Governance, and Mortality: The Impact of Prescription Drug Monitoring Programs on U.S. Overdose Mortality, 2000-2016.

Policy mechanisms shaping population health take numerous forms, from behavioral prohibitions to mandates for action to surveillance. Rising drug overdoses undermined the state's ability to promote population-level health. Using the case of prescription drug monitoring programs (PDMPs), we contend that PDMP implementation highlights state biopower operating via mechanisms of surveillance, whereby prescribers, pharmacists, and patients perceive agency despite choices being constrained. We consider whether such surveillance mechanisms are sufficient or if prescriber/dispenser access or requirements for use are necessary for population health impact. We test whether PDMPs reduced overdose mortality while considering that surveillance may require time to reach effectiveness. PDMPs reduced opioid overdose mortality 2 years postimplementation and sustained effects, with similar effects for prescription opioids, benzodiazepines, and psychostimulants. Access or mandates for action do not reduce mortality beyond surveillance. Overall, PDMP effects on overdose mortality are likely due to self-regulation under surveillance rather than mandated action.

Effect of a Mandatory Prescription Drug Monitoring Program on Patient-initiated Phone Calls After Spine Surgery.

This was a retrospective cohort study. The objective of this study was to determine the effect of a statewide, government-mandated prescription drug monitoring program (PDMP) on patient-initiated phone calls after lumbar and cervical spinal surgery. Prior studies have examined the most common reasons for a postoperative phone calls, most of which pertain to pain or prescription medications. However, no studies have investigated the effects of mandatory opioid prescription reporting on these calls. Patients who underwent lumbar decompression, lumbar fusion, or posterior cervical fusion were retrospectively identified. Patients were sorted into 1 of 2 cohorts based on their procedure date's relation to the initiation of the state's PDMP: "pre-PDMP" and "post-PDMP." All clinical and demographic data were obtained from electronic health records. Telephone communications from or on behalf of patients were retrospectively reviewed. Multivariable logistic regression was performed to determine independent factors associated with a postoperative phone call. Five hundred and twenty-five patients (2689 phone calls) were included in the study. Average number of phone calls per patient increased significantly after PDMP implementation among lumbar (3.27 vs. 5.18, P<0.001), cervical (5.08 vs. 11.67, P<0.001), and all (3.59 vs. 6.30, P<0.001) procedures. Age [odds ratio (OR): 1.05 (1.01, 1.09), P=0.02], cervical procedure [OR: 4.65 (1.93, 11.21), P=0.001], and a post-PDMP date of surgery [OR: 6.35 (3.55, 11.35), P<0.001] were independently associated with an increased likelihood of a postoperative phone call. A higher percentage of calls were in reference to postoperative care (4.6% vs. 2.4%, P=0.01) and wound care (4.3% vs. 1.4%, P<0.001) in the post-PDMP cohort compared with the pre-PDMP cohort. Patient-initiated telephone calls increased significantly after implementation of a mandatory statewide PDMP. Increasing age, operation involving the cervical spine, and surgery occurring after implementation of the state's PDMP were independently associated with an increased likelihood of postoperative phone call to health care providers.

Primary Care Implementation of a Mandatory Prescription Drug Monitoring Program in New York City.

The ways in which prescription drug monitoring programs (PDMPs) have been integrated into clinical practice remain understudied, and research into PDMP implementation in states where PDMP use by providers is mandated remains scant. This qualitative study describes how use of a state-mandated PDMP influenced clinical practice and opioid analgesic prescribing. We conducted face-to-face, in-depth interviews with 53 New York State-licensed primary care physicians who reported that they currently prescribed opioid analgesic medication, including those providers who reported consistent use of the PDMP (n = 38) in this sample. We used a thematic analytic approach to identify patterns of PDMP implementation into practice following enactment of the New York State legislative usage mandate. Among physicians who consistently used the PDMP, we found two distinct groups: (1) physicians who reported no change in their clinical practice and (2) physicians who acknowledged changes to both clinical practice and administrative management. In the latter group, most physicians felt the PDMP had benefited their patient relationships by fostering dialogue around patient substance use; however, some used the PDMP to dismiss patients from care. Findings suggest that increased education for providers relating to judicious prescribing, opioid use disorder, and best practice for PDMP utilization are needed.

150. The effect of online prescription drug monitoring on opioid prescription habits after single level lumbar fusion

<h3>BACKGROUND CONTEXT</h3> The United States opioid epidemic is a well-documented crisis stemming from increased prescription of narcotics, leading to widespread misuse of both prescription and nonprescription opioid pain relievers. To combat this epidemic, online prescription drug monitoring programs (PDMPs) have been implemented at the state level to track prescriptions of controlled substances and mitigate potential misuse and addiction. <h3>PURPOSE</h3> To evaluate prescription trends of opioids over time following implementation of an online PDMP in patients who underwent single-level lumbar fusion. <h3>STUDY DESIGN/SETTING</h3> Retrospective cohort analysis. <h3>PATIENT SAMPLE</h3> Patients 18 years of age or older who underwent single-level lumbar fusion for spinal stenosis, spondylolisthesis, or disc herniation. <h3>OUTCOME MEASURES</h3> Pre- and postoperative per-patient average total opioid prescriptions, prescriptions obtained by private pay, number of prescribers, number of pharmacies, number of pills/liquid doses, refills, duration of use (days), total milligram morphine equivalents (MME) per patient, preoperative opioid naivety (defined as no documented opioid prescription within one year prior to surgery), and postoperative chronic opioid use (defined as filling ten or more prescriptions, or receiving 120 or more days of opioid prescriptions, within the first year after surgery excluding the initial 90-day postoperative period). <h3>Methods</h3> Patients who underwent single-level lumbar fusion between January 1st, 2017 and December 30, 2019 were identified. Patients were placed into one of two cohorts: (1) patients whose procedure occurred during 2017, the first calendar year following implementation of the local online PDMP, and (2) patients whose procedures occurred during 2019. Opioid use data was obtained by searching for each patient in the state government's online PDMP and recording data within the year prior to and the year following the patient's procedure. <h3>Results</h3> A total of 393 patients were included in the study. One hundred seventy-two were included in the 2017 cohort, while 221 were included in the 2019 cohort. Preoperatively, the 2019 cohort obtained significantly greater average of preoperative prescription opioids via private pay compared to 2017 (0.4 ± 1.5 vs 0.1 ± 1.6, p=0.01). Postoperatively, the 2019 cohort obtained on average a greater total number of opioid prescriptions (4.0 ± 6.1 vs 2.8 ± 4.9, p=0.046), and obtained opioid prescriptions from a greater average number of prescribers (1.8 ± 1.4 vs 1.4 ± 1.6, p=0.01) and pharmacies (1.1 ± 0.7 vs 0.8 ± 0.8, p=0.001). <h3>Conclusions</h3> Despite implementation of an online PDMP, increases were found from 2017 to 2019 in per-patient preoperative prescriptions obtained by private pay as well as average total postoperative opioid prescriptions and average number of prescribers and pharmacies. While the exact effect of different strategies aimed at decreasing the misuse and abuse of narcotic medications is unclear, use of an online PDMP is not sufficient to discourage opioid use in patients undergoing single-level lumbar fusion. Future studies should determine the effect of other strategies, such as pain management modalities that do not involve opioid prescriptions, on discouraging opioid abuse. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Pharmacists should treat patients who have opioid use disorders, not police them

Pharmacists are caught in the throes of a relentless overdose crisis that has already claimed half a million lives and threatens to claim thousands more. The addiction treatment system is fragmented and inadequate to meet demand. Few physicians provide medications for opioid use disorder (MOUDs), the most effective form of evidence-based treatment, and insufficient treatment options leave patients vulnerable to overdose.Pharmacists routinely interact with patients who have OUD but lack ways to treat them. The primary tools that pharmacists have received to curb the crisis are prescription drug monitoring programs (PDMPs), big data surveillance technologies that they can use to track patients’ medication acquisition patterns. Pharmacists like PDMPs because they help them make decisions efficiently. However, PDMPs are enforcement technologies, not health care tools; therefore, pharmacists typically use PDMPs to police patients instead of treating them. Policing patients not only fails to help combat overdose, but can also exacerbate harm.Informed by a decade’s worth of interviews with pharmacists before and after PDMP implementation, I argue that pharmacists should be better equipped to help patients with OUD. Specifically, clinical and community pharmacists should mobilize to provide MOUDs through collaborative practice agreements with physicians. Studies show that collaborative practice models are effective at reducing the risk of overdose and saving money and physicians’ time. And pharmacists have the clinical competencies necessary to provide MOUDs for patients. Pharmacists must overcome legal, economic, and interprofessional barriers to do so, but giving pharmacists the tools to treat patients will affirm their professional commitment to caring for patients and saving lives.

Impact of Florida’s prescription drug monitoring program on drug- related fatal vehicle crashes: a difference-in-differences approach

BackgroundPrescription drug use has soared in the USA within the last two decades. Prescription drugs can impair motor skills essential for the safe operation of a motor vehicle, and therefore...