Preventing Opioid Abuse Through Mandatory Prescription Drug Monitoring Programs

Tuesday, December 11th, 2018 Margaret DeckerDecember 11th, 2018 • Bookmarks: 101

A smattering of loose prescription pills surround bottles and US currency.

A new study suggests that mandatory physician-led monitoring of opioid prescriptions may be an important tool in the effort to combat opioid abuse. The opioid epidemic is an increasingly serious problem in the United States, with over 50,000 people killed by opioid overdoses in 2017. President Trump declared the crisis a National Public Health Emergency, and there has been bipartisan agreement on a package of interventions that includes expanding access for substance abuse treatment, preventing opioids from entering the U.S. via mail, and increasing funding for research on non-addictive pain relief.

The crisis has been exacerbated by physicians over-prescribing opioids. The Center for Disease Control (CDC) reports that for those most at risk of overdose, physicians are the primary source of opioids. Many opioid users “doctor shop” by visiting multiple disparate providers to request opioids. “Doctor shopping” can also provide a source of prescription drugs that are then sold on the street. To address this issue, all 50 states and the District of Columbia have adopted Prescription Drug Monitoring Programs (PDMPs), which use online databases to track the prescription and dispensation of opioids on an individual patient level. Through PDMPs, doctors and pharmacists can track which patients are exhibiting “doctor shopping” behavior or are at risk of opioid abuse. In some states, providers are required to query a PDMP before giving a patient access to opioids, while in others, PDMP use is optional.

This 2017 study by Dave, Grecu, and Saffer finds that mandatory PDMPs are associated with lower levels of substance abuse treatment center admissions by state. These findings are a departure from previous analyses of PDMPs, which did not distinguish between mandatory PDMPs and voluntary ones and found no impact of PDMPs on opioid abuse. Dave, Grecu, and Saffer posit that this is due to low levels of PDMP access in states without mandatory-access provisions, where only 14 to 25 percent of physicians use PDMP data.

These results come from the authors’ analysis comparing trends in opioid abuse in states with mandatory PDMPs to states with voluntary ones. The data for this study was obtained from the Substance Abuse and Mental Health Services Administration’s Treatment Episode Data Set (TEDS), which contains demographic and substance abuse information from treatment center admissions. The authors’ outcome of interest is admissions to federally-funded substance abuse treatment centers. They take advantage of the fact that different states adopted regulations mandating access to PDMPs at different time periods between 2003 and 2014.

This analysis attempts to control for several factors that could bias the results, such as demographic differences between states with voluntary vs. mandatory PDMPs or a state’s adoption of other opioid-related policies. In addition, the authors include time and state fixed effects in their regression model along with covariates like unemployment rate and income per capita. They also sort the treatment facility admissions by age group due to known variations in the driving factors behind opioid misuse by age, thereby accounting for similar variations in opioid prescription and treatment. These considerations and controls allow the researchers to conclude that the impact on admission rates can be attributed solely to mandatory PDMP laws.

Though admission to federally funded treatment centers is only one indicator of opioid abuse, the reduction in admissions suggests that mandatory PDMPs are an important area of focus. As PDMP infrastructure is already in place nationwide, mandating that physicians use the available data before prescribing opioids is a straightforward and simple next step. Other supplemental policies to support provider use of PDMPs could include training in hospitals, clinics and pharmacies, emphasizing the role of physicians in ending the opioid epidemic. Increasing the use of this crucial PDMP data will have a significant impact on preventing opioid abuse and ending overdose in the United States.