Implementation Of Prescription Drug Monitoring Programs Research Articles

Prescription Drug Monitoring Programs.

According to the Centers for Disease Control and Prevention (CDC), more than 36,000 individuals were victims of a fatal drug overdose in 2008.1 The majority of these deaths were related to prescription drug abuse, most frequently opioid analgesics. Multiple factors have contributed to the severity of opioid abuse and misuse in the United States, including a substantial increase in the number of opioid prescriptions dispensed by retail pharmacists (from an estimated 76 million in 1991 to over 200 million from 2009 to 2013), more social acceptability for administering medications for different purposes, and an increase in marketing of medications.2 As part of a multifaceted effort to curb the increase in prescription drug abuse, the majority of states have implemented prescription drug monitoring programs (PDMPs). These programs “collect, monitor, and analyze electronically transmitted prescribing and dispensing data submitted by pharmacies and dispensing practitioners.”3 The overarching goal of this data collection and analysis is to support efforts related to enforcement, education, research, and abuse prevention. Although almost all states have a PDMP (excluding Missouri), state laws and rules governing these programs vary significantly. It is important for pharmacists and prescribers to be familiar with their state laws. A comprehensive listing of all state PDMP Web sites may be found at: http://www.pdmpassist.org/content/state-pdmp-websites.4 In addition, the National Alliance for Model State Drug Laws maintains an up-to-date site on the status of PDMP legislation at: http://www.namsdl.org/prescription-monitoring-programs.cfm.5 Administration of PDMP programs is performed by the individual state; the federal Drug Enforcement Agency (DEA) is not involved with the administration of any state PDMP.6 The state agency responsible for PDMP oversight varies, with boards of pharmacy and departments of health being the most common state agencies involved in PDMP administration.7 Most states collect and analyze data on use of schedule II to V controlled substances; however, some states only collect data on schedule II to IV substances, and one state (Pennsylvania) monitors the use of schedule II medications only. Access to information within the PDMP is determined by state law and is generally limited. Prescribers and pharmacists are allowed to obtain reports on patients under their direct care in most states. Some states also provide access to PDMP information to law enforcement, licensing and regulatory boards, state Medicaid programs, medical examiners or coroners, and certain research organizations. Although PDMP implementation has resulted in progress in combating drug diversion and abuse, there are still deficiencies that need to be addressed. Shepherd listed these PDMP deficiencies as inadequate data collection, ineffective utilization of data, insufficient interstate data sharing, and underuse of certain information by law enforcement.7 Table 1 provides comments on the deficiencies present in each category. Table 1. Deficiencies of prescription drug monitoring programs7 In conclusion, pharmacists need to be aware of state laws and rules regarding PDMPs. These laws and rules vary significantly from state to state. Although PDMPs have helped to combat prescription drug abuse and diversion, there are still deficiencies in these systems that need to be addressed.

Abrupt decline in oxycodone-caused mortality after implementation of Florida's Prescription Drug Monitoring Program

BackgroundIn Florida, oxycodone-caused deaths declined substantially in 2012. Multiple important law enforcement, pharmaceutical, policy, and public health actions occurred concurrently, including implementation of a statewide Prescription Drug Monitoring Program (PDMP). The effects of the PDMP on oxycodone-caused mortality in Florida were evaluated. MethodsA time-series, quasi-experimental research design with autoregressive integrated moving average (ARIMA) statistical models, including internal and external covariates. Data included 120 repeated monthly observations. Monthly counts of oxycodone-caused deaths, obtained from the Florida Medical Examiners Commission (MEC) was the outcome variable. Models included market-entry of tamper-resistant oxycodone HC1 controlled release tablets (OxyContin®), enforcement crackdowns (Operation Pill Nation), and regulation by FL House Bill 7095, measured by the monthly count of Florida pain management clinics closed. Two approaches were used to test the PDMP's hypothesized effect: (1) a binary indicator variable (0=pre-implementation, 1=post-implementation), and (2) a continuous indicator consisting of the number of PDMP queries by health care providers. ResultsOxycodone-caused mortality abruptly declined 25% the month after implementation of Florida's PDMP (p=0.008). The effect remained after integrating other related historical events into the model. Results indicate that for a system-wide increase of one PDMP query per health care provider, oxycodone-caused deaths declined by 0.229 persons per month (p=0.002). ConclusionsThis is the first study to demonstrate that the PDMP had a significant effect in reducing oxycodone-caused mortality in Florida. Results have implications for national efforts to address the prescription drug epidemic.

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.

Prescription Drug Monitoring Programs, a Response to Doctor Shopping: Purpose, Effectiveness, and Directions for Future Research

Prescription drug abuse is a major worldwide problem and its incidence is on the rise, resulting in a huge societal cost. Prescription drug monitoring programs (PDMPs) are electronic databases that collect data on controlled substances so that health care providers can access the data and deter abuse, doctor shopping, and diversion. Currently only a few countries, including the United States and France, have operational PDMPs. The purpose of this paper is to review the literature on prescription drug monitoring programs. There is a paucity of research articles in this area; only 11 articles were published on this topic and relevant in the last ten years. Four themes were identified, (1) the effect of PDMPs on prescribing practices and the effect of PDMPs on the public, (2) the effect of PDMPs on prescribing practices and multiple provider episodes, (3) the effect of PDMPs on prescribing practices and characteristics of patients, and (4) health care professionals’ perspectives on PDMPs. Studies have shown that PDMPs decrease diversion and doctor shopping. Despite implementation of PDMPs, prescription drug rates for controlled substances and abuse rates have risen. There is an urgent need for understanding and research on this topic so that action can be taken.

Attitudes of Florida pharmacists toward implementing a state prescription drug monitoring program for controlled substances.

As of May 23, 2011, 35 states had an operational prescription drug monitoring program (PDMP), and 13 additional states, including Florida in 2009, had passed legislation to implement a PDMP. PDMPs, electronic databases that collect and track designated data on controlled substances and other commonly abused medications, are intended to serve as a tool for health care practitioners when prescribing and dispensing controlled substances to reduce drug abuse and diversion. In an analysis of 1,268 drug-caused deaths from January through June 2010 in Florida, the top 3 prescription drugs included the controlled substances oxycodone (56%), alprazolam (35%), and methadone (26%), all of which would be subject to reporting in Florida's PDMP when implemented. Because pharmacists are the health care professionals most affected by PDMP reporting requirements, evaluating their attitudes about PDMP implementation is important. To assess Florida pharmacists' attitudes toward implementing a PDMP in the state. This was a cross-sectional study conducted in Florida between February 2010 and June 2010 prior to the implementation of the proposed PDMP. A random sample of 5,000 of approximately 26,000 pharmacists licensed in Florida was invited to participate in a voluntary and anonymous 10-question self-administered mail survey of which 4 survey items assessed pharmacists' attitudes towards implementing a PDMP in the state. Of the 5,000 pharmacists contacted by mail, 911 (18.2%) completed the survey, of whom 836 responded to the items assessing opinions about PDMPs and provided practice site information. A majority of pharmacists across all practice settings agreed or strongly agreed with the statements that a PDMP "should be implemented in Florida" (chain 84.0%, hospital 74.2%, independent 77.9%, and other 71.1%) and that a PDMP would decrease "the incidence of doctor shopping" if implemented (chain 80.8%, hospital 67.2%, independent 71.7%, and other 63.3%). A majority of pharmacists across all practice settings disagreed or strongly disagreed with the statements that they would be "discouraged to dispense controlled substances" by the PDMP (chain 61.4%, hospital 50.0%, independent 60.2%, and other 63.8%) and that PDMP implementation would be "an invasion of patients' privacy" (chain 80.3%, hospital 67.7%, independent 67.3%, and other 69.3%). In a small-sample survey, a majority of Florida pharmacists across all practice settings were in favor of implementing a PDMP in Florida. This is the first study to examine Florida pharmacists' attitudes toward PDMP implementation, and the results should prompt future analyses of relevant outcomes, such as drug abuse, drug-related mortality, and doctor shopping.