Has prescription monitoring reduced opioid misuse?

Opioid misuse has become a serious public health problem, with more than 800,000 overdose deaths during the last two decades in the United States alone.

To help health care providers make better-informed decisions about patient drug use, policymakers in nearly every U.S. state implemented electronic databases where pharmacists provide information about each controlled substance dispensed.

These prescription drug monitoring programs (PDMPs) vary from state to state, however. The most comprehensive programs have “must access” provisions that require physicians to review the prescribing history, and the research to date has found these to be the most effective at reducing opioid use.

Benjamin Ukert, PhD, assistant professor at the Texas A&M University School of Public Health, and Johns Hopkins University researcher Daniel Polsky, PhD, built on the existing PDMP research by further examining the mechanisms by which PDMP policies are effective in reducing opioid prescribing in the long-term.

Their study, published in the Journal of American Health Economics, used nationwide health insurance claim data from 2010 to 2014 to analyze opioid prescription use following emergency department (ED) visits.

In their analysis, Ukert and Polsky grouped state PDMPs into three categories: “limited” states where the laws applied only to pain clinic care and the dispensing of methadone; “discretionary” states where providers were required to access monitoring data only if they suspected opioid abuse; and comprehensive, “broad” states where review was required in all care settings and for all controlled substances.

In addition, the researchers divided patients into those who had not received opioids within six months prior to their ED visit—referred to as opioid naive—and non-naive patients who had taken opioids during that period. They did this to further delineate previous research findings that identified two factors that have a role in reducing opioid use and misuse with PDMPs: the “hassle cost” of having to access monitoring data, and the information within the monitoring data that can point to opioid misuse and affect prescribing actions.

Like previous researchers, Ukert and Polsky found that the broadest and strictest PDMPs were the most effective at reducing long-term opioid use, which they defined as a patient using a 180-day supply or more within a year of visiting the ED. They also found that hassle cost accounted for the majority of opioid prescribing reductions within seven days of an ED visit.

When looking at long-term effects, however, they found that PDMP information had a far greater effect than hassle cost. These effects were even stronger when focusing on non-naive patients and in states with higher rates of opioid use.

While this analysis shows how broad PDMPs can reduce opioid prescribing in both the short term and long term, especially for non-naive patients, it found little effect on the supply and strength of opioids prescribed. This points to a possible need for further development of PDMPs to focus on the quantity and types of opioids being prescribed and for guidelines that inform acceptable dosages.

For policymakers, the study results imply that “must access” PDMPs increase the time cost of prescribing to physicians for new and established patients and provide an objective information system on the extent of historic opioid use of patients.

“This suggests substantial room for improvement in clinical prescribing guidelines in the ED, and more generally for individuals with a history of opioid use,” said Ukert.

“For health systems, the implications of this study are that despite efforts by state officials, many PDMPs are ineffective. More importantly, providers can implement policies that require access to the system, even when no state mandate exists.”

Having more effective tools to decrease the odds of opioid misuse could help reduce future overdoses and deaths while still allowing the use of these drugs for effective pain management.