Effect Of Prescription Drug Monitoring Programs Research Articles

Characteristics of statewide prescription drug monitoring programs and potentially inappropriate opioid prescribing to patients with non-cancer chronic pain: A machine learning application

Unnecessary/unsafe opioid prescribing has become a major public health concern in the U.S. Statewide prescription drug monitoring programs (PDMPs) with varying characteristics have been implemented to improve safe prescribing practice. Yet, no studies have comprehensively evaluated the effectiveness of PDMP characteristics in reducing opioid-related potentially inappropriate prescribing (PIP) practices. The objective of the study is to apply machine learning methods to evaluate PDMP effectiveness by examining how different PDMP characteristics are associated with opioid-related PIPs for non-cancer chronic pain (NCCP) treatment. This was a retrospective observational study that included 802,926 adult patients who were diagnosed NCCP, obtained opioid prescriptions, and were continuously enrolled in plans of a major U.S. insurer for over a year. Four outcomes of opioid-related PIP practices, including dosage ≥50 MME/day and ≥90 MME/day, days supply ≥7 days, and benzodiazepine-opioid co-prescription were examined. Machine learning models were applied, including logistic regression, least absolute shrinkage and selection operation regression, classification and regression trees, random forests, and gradient boost modeling (GBM). The SHapley Additive exPlanations (SHAP) method was applied to interpret model results. The results show that among 1,886,146 NCCP opioid-related claims, 22.8% had an opioid dosage ≥50 MME/day and 8.9% ≥90 MME/day, 70.3% had days supply ≥7 days, and 10.3% were when benzodiazepine was filled ≤7 days ago. GBM had superior model performance. We identified the most salient PDMP characteristics that predict opioid-related PIPs (e.g., broader access to patient prescription history, monitoring Schedule IV controlled substances), which could be informative to the states considering the redesign of PDMPs.

Effects of Implementation and Enforcement Differences in Prescription Drug Monitoring Programs in 3 States: Connecticut, Kentucky, and Wisconsin

Background and aims:Prescription Drug Monitoring Programs (PDMPs) were designed to curb opioid misuse and diversion by tracking scheduled medications prescribed by medical providers and dispensed by pharmacies. The effects of PDMPs on opioid prescription, misuse and overdose rates have been mixed due in part to variability in states’ PDMPs and difficulties measuring this complexity, and a lack of attention to implementation and enforcement of PDMP components. The current study uses qualitative interviews with key informants from 3 states with different PDMPs, Connecticut, Kentucky and Wisconsin to explore differences in the characteristics of the PDMPs in each state; how they are implemented, monitored and enforced; and unintended negative consequences of these programs.Methods:We conducted in-depth interviews with key informants from each state representing the following sectors: PDMP and pain clinic regulation agencies, Medicaid programs, state licensing boards, pharmacies, emergency medicine departments, pain management clinics, first responders, drug courts, drug treatment programs, medication assisted treatment (MAT) providers, and harm reduction organizations. Interview guides explored participants’ experiences with and opinions of PDMPs according to their roles. Data analysis was conducted using a collaborative, constant comparison method.Results:While all 3 states had mandated registration and reporting requirements, the states differed in the implementation and enforcement of these and the extent to which provider prescribing was monitored. These, in turn, influenced how medical providers perceived the PDMP and changed how providers prescribed opioids. Unintended consequences of state PDMPs included under-prescribing for pain and “dumping” patients who were long term users of opioids or who had developed opioid use disorders and may explain the increase in illicit heroin or opioid use.Conclusion:State PDMPs with similar mandates may differ greatly in implementation and enforcement. These differences are important to consider when determining the effects of PDMPs on opioid misuse and overdose.

Evaluation of Australian prescription drug monitoring programs need a holistic approach.

Prescription opioid-related mortality is increasing in Australia. Real-time Prescription Drug Monitoring Programs (PDMPs) have recently been implemented as a strategy to reduce opioid-related harm. PDMPs enable prescribers and dispensers to view patients' prescription history before writing or dispensing a high-risk medication. This article considers the complexity of accurately evaluating PDMP effectiveness. To ensure sustainable implementation of these systems in Australia, a wide range of outcomes need to be measured. These include any unintended consequences and impacts on comprehensive patient care. Furthermore, intervention evaluation may be disrupted by concurrent interventions, limited methodologies and the shortcomings of the current approach.

A Rapid Review of the Impact of Systems-Level Policies and Interventions on Population-Level Outcomes Related to the Opioid Epidemic, United States and Canada, 2014-2018.

In the United States, rising rates of overdose deaths and recent outbreaks of hepatitis C virus and HIV infection are associated with injection drug use. We updated a 2014 review of systems-level opioid policy interventions by focusing on evidence published during 2014-2018 and new and expanded opioid policies. We searched the MEDLINE database, consistent with the 2014 review. We included articles that provided original empirical evidence on the effects of systems-level interventions on opioid use, overdose, or death; were from the United States or Canada; had a clear comparison group; and were published from January 1, 2014, through July 19, 2018. Two raters screened articles and extracted full-text data for qualitative synthesis of consistent or contradictory findings across studies. Given the rapidly evolving field, the review was supplemented with a search of additional articles through November 17, 2019, to assess consistency of more recent findings. The keyword search yielded 535 studies, 66 of which met inclusion criteria. The most studied interventions were prescription drug monitoring programs (PDMPs) (59.1%), and the least studied interventions were clinical guideline changes (7.6%). The most common outcome was opioid use (77.3%). Few articles evaluated combination interventions (18.2%). Study findings included the following: PDMP effectiveness depends on policy design, with robust PDMPs needed for impact; health insurer and pharmacy benefit management strategies, pill-mill laws, pain clinic regulations, and patient/health care provider educational interventions reduced inappropriate prescribing; and marijuana laws led to a decrease in adverse opioid-related outcomes. Naloxone distribution programs were understudied, and evidence of their effectiveness was mixed. In the evidence published after our search's 4-year window, findings on opioid guidelines and education were consistent and findings for other policies differed. Although robust PDMPs and marijuana laws are promising, they do not target all outcomes, and multipronged interventions are needed. Future research should address marijuana laws, harm-reduction interventions, health insurer policies, patient/health care provider education, and the effects of simultaneous interventions on opioid-related outcomes.

The Effect of Mandatory-Access Prescription Drug Monitoring Programs on Foster Care Admissions

The opioid epidemic is a national public health emergency. As the number of fa- tal overdoses and drug abuse skyrockets, children of opioid-dependent parents are at increased risk of being neglected, abused or orphaned. While some studies have examined the effects of policies introduced by states to restrict prescription drug supply on drug abuse, there is no study analyzing their effects on children. This paper estimates the effect of must-access prescription drug monitoring programs (PDMPs) on child removals. To identify the effects of the programs on foster care caseloads, we exploit the variation across states in the timing of adoption of must-access PDMPs using an event-study approach as well as standard difference-in-difference models. Consistent with previous evidence examining the effects of PDMPs on drug abuse, we find that operational PDMP did not have any significant effects on foster care caseloads. However, the introduction of mandatory provisions reduced child removals by 10%. Exploring the reasons of removals, we show that these effects are driven by the reductions in cases of child neglect. There is also evidence of significant reductions in removal cases associated with child physical abuse.

Prescription drug monitoring programs and neonatal outcomes

Over the last two decades, the number of delivering mothers using or dependent on opiates has increased dramatically, giving rise to a five-fold increase in the proportion of babies born with neonatal abstinence syndrome (NAS). First, the current study documents NAS trends in the United States and their substantial variation across states. Second, it explores the relationship, if any, between the adoption of prescription drug monitoring programs (PDMPs) and reductions in NAS incidence across the United States. We find that the introduction of operational PDMPs reduced NAS incidence in the United States by 10%. We also examined the effects on birth outcomes, infant mortality, and other pregnancy complications and find little evidence of any effect of PDMPs on birth weight, premature births, and infant mortality.

Obstetrician/Gynecologist Perception of Prescription Drug Monitoring Program Effectiveness [15I

INTRODUCTION: Prescription drug monitoring programs (PDMPs) are primary prevention tools designed to reduce rising rates of substance use disorders (SUD) and sequelae such as neonatal abstinence syndrome. Evidence regarding OB/GYN perceptions of PDMPs, which may impact PDMP utilization, is unavailable. This study examines perceived PDMP effectiveness among OB/GYNs compared to primary care physicians (PCPs). METHODS: In the absence of national-level data, independent surveys of PDMP users in Florida, Kentucky, and California were evaluated based on a Likert-type item to assess perception of PDMP effectiveness in reducing prescription drug abuse and diversion. Response distributions of OB/GYNs versus PCPs were compared using chi square tests for each state. RESULTS: In Florida, there were 41 OB/GYN and 511 PCP respondents; Kentucky, 46 OB/GYNs and 265 PCPs; and California, 41 OB/GYNs and 162 PCPs. In each state OB/GYNs viewed PDMPs as less effective, positive, or useful compared to PCPs (p≤0.01, all states). Florida: 64.1% OB/GYN vs. 83.7% PCP “agree positive impact”. Kentucky: 45.0% OB/GYN vs. 68.5% PCP “effective”. California: 73.2% OB/GYN vs. 86.4% PCP “useful”. CONCLUSION: These results suggest OB/GYNs view their state's PDMP as less effective than do PCPs. These perceptions may present barriers to PDMP utilization and decrease opportunities for SUD interventions. Outreach and guidelines to OB/GYNs regarding PDMP effectiveness as a SUD screening tool would be helpful. Further engagement of all prescribers, including OB/GYNs, is needed to inform future strategies, programs, policies and PDMP features to increase PDMP effectiveness.

Perception of prescription drug monitoring programs as a prevention tool in primary medical care.

Prescription drug monitoring programs (PDMPs) are primary prevention tools to reduce substance use disorders (SUD) and sequelae. Evidence regarding perceptions of PDMPs from different primary care providers, which may impact PDMP utilization for women, is unavailable. To examine perceived PDMP effectiveness among obstetrician-gynecologists (OB/GYNs) compared to primary care physicians (PCPs). Independent surveys of PDMP users in Florida, Kentucky, and California were evaluated based on a Likert-type item to assess perception of PDMP effectiveness in reducing prescription drug abuse and diversion. Response distributions of OB/GYNs versus PCPs were compared using chi-square tests. In Florida, there were 41 OB/GYN and 511 PCP respondents; Kentucky, 46 OB/GYNs and 265 PCPs; and California, 41 OB/GYNs and 162 PCPs. In each state OB/GYNs viewed PDMPs as less effective, positive, or useful compared to PCPs (p ≤ 0.01, all states): Florida: 64.1% OB/GYN vs. 83.7% PCP "agree positive impact"; Kentucky: 45.0% OB/GYN vs. 68.5% PCP "effective". California: 73.2% OB/GYN vs. 86.4% PCP "useful". These results suggest OB/GYNs view their state's PDMP as less effective than do PCPs, which may present barriers to PDMP utilization and decrease opportunities for SUD interventions. Engagement of all healthcare team members is needed to inform future strategies and policies to increase PDMP effectiveness.

Prescription Drug Monitoring Programs and Neonatal Outcomes

Over the last two decades, the number of delivering mothers using or dependent on opiates has increased dramatically, giving rise to a five-fold increase in the proportion of babies born with neonatal abstinence syndrome (NAS). First, the current study documents NAS trends in the United States and their substantial variation across states. Second, it explores the relationship, if any, between the adoption of prescription drug monitoring programs (PDMPs) and reductions in NAS incidence across the United States. We find that the introduction of operational PDMPs reduced NAS incidence in the United States by 10%. We also examined the effects on birth outcomes, infant mortality, and other pregnancy complications and find little evidence of any effect of PDMPs on birth weight, premature births, and infant mortality.

Interstate data sharing of prescription drug monitoring programs and associated opioid prescriptions among patients with non-cancer chronic pain

All fifty states have implemented prescription drug monitoring programs (PDMPs) to reduce misuse and diversion of controlled drugs. Interstate PDMP data sharing has been called for by clinical practitioners, but evidence to support the effectiveness of PDMP data sharing is lacking. This study examined whether PDMP interstate data sharing with bordering states was associated with prescriptions of opioids. This was a cross-sectional study that included patients with non-cancer chronic pain from the 2014 National Ambulatory Medical Care Survey (weighted N = 66,198,751; unweighted N = 2846). Multinomial logistic regression was performed to examine the association between PDMP interstate data sharing status and patients' being prescribed opioids for pain treatment, controlling for covariates guided by the Eisenberg's model of physician decision-making. Findings indicated that patients residing in states with interstate PDMP data sharing with all or partial bordering states were not less likely to be prescribed opioids compared to those living in states without interstate data sharing. Other factors such as patient age, health insurance type, new patient status, and physician adoption of electronic medical records were associated with the likelihood of patients' being prescribed opioids. This study concluded that current practice of interstate PDMP data sharing with bordering states was not associated with patients' being prescribed opioids for non-cancer chronic pain treatment. Future studies and policy efforts that unravel technological, legal, and political barriers to reciprocal and equal interstate data sharing with bordering states should be warranted to inform PDMP redesign and in turn, augment overall PDMP effectiveness in reducing misuse of prescription opioids.

The Impact of Prescription Drug Monitoring Programs on U.S. Opioid Prescriptions

This paper seeks to understand the treatment effect of Prescription Drug Monitoring Programs (PDMPs) on opioid prescription rates. Using county-level panel data on all opioid prescriptions in the U.S. between 2006 and 2015, we investigate whether state interventions like PDMPs have heterogeneous treatment effects at the sub-state level, based on regional and temporal variations in policy design, extent of urbanization, race, and income. Our models comprehensively control for a set of county and time fixed effects, county-specific and time-varying demographic controls, potentially endogenous time-series trends in prescription rates, and other state-level opioid interventions such as Naloxone Access and Good Samaritan laws, Medicaid expansion, and the provision of Methadone Assistance Treatment. We find that PDMPs are only effective in reducing prescription rates if they obligate doctors to check for patients’ history prior to filling out a prescription, but the frequency at which a state requires its PDMP to be updated is irrelevant to its effectiveness. Moreover, the significant treatment effects of PDMPs are almost exclusively driven by urban and predominantly white counties, with the relatively more affluent regions showing greater responsiveness than their less affluent counterparts.

The Effects of Mandatory Prescription Drug Monitoring Programs on Foster Care Admissions

The opioid epidemic is a national public health emergency. As the number of fa- tal overdoses and drug abuse skyrockets, children of opioid-dependent parents are at increased risk of being neglected, abused or orphaned. While some studies have examined the effects of policies introduced by states to restrict prescription drug supply on drug abuse, there is no study analyzing their effects on children. This paper estimates the effect of must-access prescription drug monitoring programs (PDMPs) on child removals. To identify the effects of the programs on foster care caseloads, we exploit the variation across states in the timing of adoption of must-access PDMPs using an event-study approach as well as standard difference-in-difference models.Consistent with previous evidence examining the effects of PDMPs on drug abuse, we find that operational PDMP did not have any significant effects on foster care caseloads. However, the introduction of mandatory provisions reduced child removals by 10%. Exploring the reasons of removals, we show that these effects are driven by the reductions in cases of child neglect. There is also evidence of significant reductions in removal cases associated with child physical abuse.

The Impact of Prescription Drug Monitoring Programs on U.S. Opioid Prescriptions.

This paper seeks to understand the treatment effect of Prescription Drug Monitoring Programs (PDMPs) on opioid prescription rates. Using county-level panel data on all opioid prescriptions in the U.S. between 2006 and 2015, we investigate whether state interventions like PDMPs have heterogeneous treatment effects at the sub-state level, based on regional and temporal variations in policy design, extent of urbanization, race, and income. Our models comprehensively control for a set of county and time fixed effects, countyspecific and time-varying demographic controls, potentially endogenous time-series trends in prescription rates, and other state-level opioid interventions such as Naloxone Access and Good Samaritan laws, Medicaid expansion, and the provision of Methadone Assistance Treatment. We find that PDMPs are only effective in reducing prescription rates if they obligate doctors to check for patients' history prior to filling out a prescription, but the frequency at which a state requires its PDMP to be updated is irrelevant to its effectiveness. Moreover, the significant treatment effects of PDMPs are almost exclusively driven by urban and predominantly white counties, with the relatively more affluent regions showing greater responsiveness than their less affluent counterparts.

The Effect of Prescription Drug Monitoring Programs on Opioid Prescriptions and Heroin Crime Rates

In response to growing abuse of prescription opioid painkillers, 50 U.S. states have implemented electronic prescription drug monitoring programs (PDMPs) that record patients into a state-wide registry when a prescription opioid is received. This paper uses a difference-in-differences regression framework and interactive fixed effects factor models to identify the effect of PDMPs and two related programs on the types and strengths of opioid painkiller prescriptions filled and on rates of heroin crimes. The implementation of PDMP databases caused an 10% decrease in the amount of oxycodone shipments, with results from Medicaid prescription data pointing to larger decreases within high dosage pills. PDMPs have heterogeneous effects on heroin crime incidents across counties depending on the county's pre-policy level of prescription opioid milligrams per capita, with an 49-89% increase in heroin crime within the most opioid-dense counties, depending on model specification.

Prescription Drug Monitoring Programs Produce a Limited Impact on Painkiller Prescribing in Medicare Part D.

To measure the impact of prescription drug monitoring programs (PDMPs) on prescribing of opioid and nonopioid painkillers. 2010-2013 physician-level Medicare Part D prescribing data released by the Centers for Medicare and Medicaid Services and Propublica. Using difference-in-differences models with physician-level fixed effects, the study compares prescribing in states with and without PDMPs for opioid and nonopioid analgesics, oxycodone, hydrocodone, and opioids by controlled substances Schedules II-IV. Prescription drug monitoring programs were associated with a 5.2 percent decrease in days supply prescribed per physician for oxycodone in addition to smaller reductions for hydrocodone and opioids overall (2.8 percent and 2 percent, respectively) and a small increase in prescribing for Schedule IV opioids. PDMPs were not associated with changes for nonopioid analgesics or other opioids in Schedules II and III. The effects of PDMPs were negated in states where statutes explicitly did not require use of the PDMP. Prescription drug monitoring programs have a modest effect targeted at the high-profile drug oxycodone among the Medicare Part D population and an even smaller effect for hydrocodone and opioids in general. The findings suggest some substitution toward lower schedule opioids. Substantially addressing the widespread opioid abuse problem will require enhancing existing PDMPs or implementing new policies.

A qualitative analysis of prescribers' and dispensers' views on improving prescription drug monitoring programs.

Prescription drug abuse is epidemic in the United States (US). To help address the problem, most states operate prescription drug monitoring programs (PDMPs). PDMPs are designed to monitor and help control the distribution of controlled therapeutic medications and to assist prescribers and dispensers in making informed clinical decisions. To this end, PDMPs rely on timely and accurate data submission, as well as review of the data. Consequently, provider acceptance of these systems is essential to maximize their effectiveness. This article explores licensed prescribers' and dispensers' opinions regarding prescription drug monitoring. The study surveyed licensed prescribers and dispensers about their experiences and views on drug monitoring, prescribing and dispensing practices, and on prescription drug abuse in general. Two open-ended questions were posed as part of a larger, end-user survey. The analysis culled thematically-coded excerpts to these two questions. Respondents offered a range of comments that unearthed important disagreements among prescribers and dispensers over the administration and ethics pertaining to PDMPs. At the same time, some respondents suggested means to enhance PDMPs functionality. Attending to and rectifying providers' views, while considering their improvement suggestions may boost PDMPs effectiveness by maximizing buy-in and utilization. The potential speaks to advancing a tool that intends to help address alarming rates of prescription drug abuse.

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.

Windmills and pill mills: can PDMPs tilt the prescription drug epidemic?

Prescription drug monitoring programs (PDMPs) are state-based registries of prescriptions for specific controlled substances. This overview will describe the history and funding of these databases, address those characteristics thought to be of greatest utility for PDMPs and review current literature regarding PDMP effectiveness and their potential limitations. Although more extensive research on PDMP outcomes is needed, these databases are an essential component in ongoing efforts to establish safe and compassionate prescription opioid stewardship.

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.